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Oral itraconazole plus nasal amphotericin B for prophylaxis of invasive aspergillosis in patients with hematological malignancies

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Abstract

The use of oral itraconazole (200 mg daily) plus nasal amphotericin B (10 mg daily) for prophylaxis of invasive aspergillosis was evaluated in 164 patients with hematological malignancies at risk due to presence of neutropenia and/or steroid therapy. This prophylactic regimen was evaluated for a period of two years. Two hundred and ninety patients with similar characteristics who were observed over the three-year period prior to the introduction of prophylaxis served as historical control group. Environmental surveillance during the study period showed constant contamination of the air withAspergillus. Prophylaxis significantly reduced the incidence of proven invasive aspergillosis from 12/290 to 0/164 (p=0.004), and reduced the mortality rate from 8/290 to 0/164. The incidence of proven plus probable aspergillosis amounted to 34/290 in the control group and 8/164 in the study group (p=0.01); the mortality rates were 11/290 (3.7 %) and 2/164 (1.2 %) respectively. All nasal cultures in the study group were negative forAspergillus. The prophylactic regimen was well tolerated. Larger studies assessing each agent alone and in combination are necessary to confirm these observations.

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References

  1. Denning DW, Stevens DA Antifungal and surgical treatment of invasive aspergillosis: review of 2121 published cases. Reviews of Infectious Diseases 1990, 12: 1157–1201.

    Google Scholar 

  2. Pannuti CS, Gingrich RD, Pfaller M, Wenzel RP Nosocomial pneumonia in adult patients undergoing bone marrow transplantation: a 9 year study. Journal of Clinical Oncology 1991, 9: 77–84.

    PubMed  Google Scholar 

  3. Saral R Candida andAspergillus in immunocompromised patients: an overview. Reviews of Infectious Disease 1991, 13: 487–492.

    PubMed  Google Scholar 

  4. Aisner J, Schimpff SC, Wienik PH Treatment of invasive aspergillosis: relation of early diagnosis and treatment of response. Annals of Internal Medicine 1977, 86: 539–547.

    PubMed  Google Scholar 

  5. Meyer RD, Young LS, Armstrong D, Yu B Aspergillosis complicating neoplastic disease. American Journal of Medicine 1973, 54: 6–15.

    Article  PubMed  Google Scholar 

  6. Walsh TJ, Lee J, Lecciones J, Rubin M, Butler K, Francis P, Weinberger M, Roilides E, Marshall D, Gress J, Pizzo PA Empiric therapy with amphotericin B in febrile granulocytopenic patients. Reviews Infectious Diseases 1991, 13: 496–503.

    Google Scholar 

  7. Denning DW, Tucker RM, Hanson LH, Stevens DA Treatment of invasive aspergillosis with itraconazole. American Journal of Medicine 1989, 86: 791–800.

    Article  PubMed  Google Scholar 

  8. Meunier Carpentier F, Snoeck R, Gerain J, Muller C, Klastersky J Amphotericin B nasal spray as prophylaxis against aspergillosis in patients with neutropenia. New England Journal of Medicine 1984, 311: 1056.

    Google Scholar 

  9. Conneally E, Cafferkey MT, Daly PA, Keane CT, McCann SR Nebulized amphotericin B as prophylaxis against invasive aspergillosis in granulocytopenic patients. Bone Marrow Transplantation 1990, 5: 403–406.

    PubMed  Google Scholar 

  10. Martino P, Raccah R, Gentile G, Venditti M, Girmenia C, Mandelli F Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: a retrospective study. Haematologica 1989, 74: 263–265.

    PubMed  Google Scholar 

  11. Wiley JM, Smith N, Leventhal BG, Graham ML, Strauss LC, Hurwitz CA, Modlin J, Mellitis D, Baumgardner R, Cordn BJ, Civin CI Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors. Journal of Clinical Oncology 1990, 8: 280–286.

    PubMed  Google Scholar 

  12. Rhame FS, Streifel AJ, Kersey JH, McGlave PB Extrinsic risk factors for pneumonia in the patient at high risk of infection. American Journal of Medicine 1984, 15: 42–51.

    Article  Google Scholar 

  13. Robertson MJ, Larson RA Recurrent fungal pneumonias in patients with acute non-lymphocytic leukemia undergoing multiple courses of intensive chemotherapy. American Journal of Medicine 1988, 84: 233–239.

    Article  PubMed  Google Scholar 

  14. Musial CE, Cockerill FR, Roberts GD Fungal infections of the immunocompromised host: clinical and laboratory aspects. Clinical Microbiology Reviews 1988, 15: 349–364.

    Google Scholar 

  15. Raper KB, Fennel DI The genusAspergillus. Williams and Wilkins, Baltimore, 1965.

    Google Scholar 

  16. EORTC International Antimicrobial Therapy Cooperative Group Empiric antifungal therapy in febrile granulocytopenic patients. American Journal of Medicine 1989, 86: 668–672.

    Google Scholar 

  17. Burch PA, Karp JE, Merz WG, Kuhlman JE, Fishman EK Favorable outcome of invasive aspergillosis in patients with acute leukemia. Journal of Clinical Oncology 1987, 5: 1985–1993.

    PubMed  Google Scholar 

  18. Karp JE, Merz WG, Charache P An evaluation of the response to empiric amphotericin B during antileukemic therapy induced granulocytopenia. Reviews of Infectious Diseases 1991, 13: 592–599.

    PubMed  Google Scholar 

  19. Benhamou E, Hartmann O, Noques C, Maraninchi D, Valteau D, Lemerle J Does ketoconazole prevent fungal infection in children treated with high dose chemotherapy and bone marrow transplantation? Results of a randomized placebo-controlled trial. Bone Marrow Transplantation 1991, 7: 127–131.

    Google Scholar 

  20. Arnow PM, Andersen RL, Mainous PD, Smith EJ Pulmonary aspergillosis during hospital renovation. American Review of Respiratory Disease 1978, 118: 49–53.

    PubMed  Google Scholar 

  21. Sarubbi SA, Kopf HB, Wilson MB, McGinnis MR, Rutala WA Increased recovery ofAspergillus flavus from respiratory specimens during hospital construction. American Review of Respiratory Disease 1982, 125: 33–38.

    PubMed  Google Scholar 

  22. Weems JJ, Barry JD, Tablan OC, Kaufman L, Marton JW Construction activity: an independent risk factor for invasive aspergillosis and zygomycosis in patients with hematologic malignancy. Infection Control 1987, 8: 71–75.

    PubMed  Google Scholar 

  23. Perfect JR, Pickard WW, Hunt DL, Palmer B, Schell WA The use of amphotericin B in nosocomial fungal infection. Reviews of Infectious Diseases 1991, 13: 474–479.

    PubMed  Google Scholar 

  24. Boogaerts MA, Verhoef GE, Zachee P, Demuyck H, Verbist L, De Beule K Antifungal prophylaxis with itraconazole in prolonged neutropenia: correlation with plasma levels. Mycoses 1989, 32, Supplement 1: 103–108.

    PubMed  Google Scholar 

  25. Diamond RD The growing problem of mycoses in patients infected with the human immunodeficiency virus. Reviews of Infectious Diseases 1991, 13: 480–486.

    PubMed  Google Scholar 

  26. Denning DW, Follansbee SE, Scolaro M, Norris S, Edelstein H, Stevens DA Pulmonary aspergillosis in the acquired immunodeficiency syndrome. New England Journal of Medicine 1991, 324: 654–662.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Cattedra di Ematologia, Università di Verona, Italy

    G. Todeschini, C. Murari, R. Bonesi, G. Pizzolo, G. Amaddi, A. Ambrosetti, S. Cerù & G. Perona

  2. Servizio di Farmacia, Ospedale Policlinico di Borgo Roma, 37134, Verona, Italy

    N. Martini

  3. Direzione Sanitaria, Ospedale Policlinico di Borgo Roma, 37134, Verona, Italy

    P. Montresor

  4. Servizio di Batteriologia e Virologia, Ospedale Maggiore, 37134, Verona, Italy

    I. Piacentini

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  1. G. Todeschini
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  2. C. Murari
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  3. R. Bonesi
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  4. G. Pizzolo
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  5. G. Amaddi
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  6. A. Ambrosetti
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  7. S. Cerù
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  8. I. Piacentini
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  9. N. Martini
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  11. G. Perona
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Todeschini, G., Murari, C., Bonesi, R. et al. Oral itraconazole plus nasal amphotericin B for prophylaxis of invasive aspergillosis in patients with hematological malignancies. Eur. J. Clin. Microbiol. Infect. Dis. 12, 614–618 (1993). https://doi.org/10.1007/BF01973640

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  • DOI: https://doi.org/10.1007/BF01973640

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