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Use of amphotericin B aerosols for the prevention of pulmonary aspergillosis

Der Einsatz von Amphotericin B Aerosolen zur Prävention der pulmonalen Aspergillose

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Summary

Invasive pulmonaryAspergillus infections are increasingly recognized among severely neutropenic and/or immunosuppressed individuals. As the infections are usually acquired through the inhalation ofAspergillus conidia, at present prevention of invasive pulmonary aspergillosis consists mainly of the reduction of environmental exposure to aspergillus conidia. More recently, prophylaxis with amphotericin B aerosols has been investigated. Inhalations with amphotericin B aerosols significantly delayed mortality in an animal model of invasive pulmonary aspergillosis and high pulmonary concentrations of amphotericin B could be achieved. In man, pulmonary deposition of amphotericin B could also be demonstrated using commercially available nebulizers. Inhalations were well tolerated with little systemic absorption of the drug. In order to evaluate the efficacy of aerosol amphotericin B administrations for the prevention of invasive pulmonary aspergillosis, a prospective randomized trial has been initiated.

Zusammenfassung

Invasive pulmonale Aspergillosen werden mit zunehmender Häufigkeit bei stark neutropenischen und/oder immunsupprimierten Patienten beobachtet. Da diese Infektionen meistens durch die Inhalation von Aspergillusconidien erworben werden, besteht die derzeit wirksamste Prophylaxe in der Vermeidung der Exposition gegenüber den Aspergillusconidien in der Einatemluft. Neuerdings ist auch die prophylaktische Anwendung von Amphotericin B Aerosolen untersucht worden. Im Tiermodell konnten Inhalationen mit Amphotericin B die Mortalität an invasiven pulmonalen Aspergillosen deutlich verzögern und hohe pulmonale Amphotericin B Spiegel erzielt werden. Beim Menschen wurde mit kommerziell erhältlichen Verneblersystemen ebenfalls pulmonale Deposition von Amphotericin B nachgewiesen. Die Inhalationen wurden gut toleriert und es wurde keine wesentliche systemische Resportion des Medikamentes beobachtet. Die Wirksamkeit von Amphotericin B Aerosolen in der Prophylaxe von invasiven pulmonalen Aspergillosen wird deshalb gegenwärtig in einer prospektiven randomisierten Studie untersucht.

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Authors and Affiliations

  1. Abteilung für Hämatologie/Onkologie, Universitätsklinikum Rudolf Virchow der Freien Universität Berlin, Spandauer Damm 130, D-14050, Berlin

    J. Beyer, Claudia Weyer &  W. Siegert

  2. Strahlenklinik und Poliklnik, Universitätsklinikum Rudolf Virchow der Freien Universität Berlin, Spandauer Damm 130, D-14050, Berlin

    G. Barzen

  3. Apotheke, Universitätsklinikum Rudolf Virchow der Freien Universität Berlin, Spandauer Damm 130, D-14050, Berlin

    Gisa Risse

  4. Abteilung für Hämatologie/Onkologie, Universitätsklinikum Steglitz der Freien Universität Berlin, Hindenburgdamm 45, D-12200, Berlin

    S. Schwartz

  5. Institut für Thermische Strömungsmaschinen, Technische Universität Karlsruhe, Kaiserstraße 12, D-76128, Karlsruhe, Germany

    K. Dullenkopf

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Beyer, J., Weyer, C., Siegert, W. et al. Use of amphotericin B aerosols for the prevention of pulmonary aspergillosis. Infection 22, 143–148 (1994). https://doi.org/10.1007/BF01739026

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