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Medientyp:
E-Artikel
Titel:
An evaluation of nebulised amphotericin B deoxycholate (Fungizone®) for treatment of pulmonary aspergillosis in the UK National Aspergillosis Centre
Beteiligte:
Otu, Akaninyene A.;
Langridge, Philip;
Denning, David W.
Beschreibung:
<jats:title>Summary</jats:title><jats:p>Antifungal treatment options for allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) are largely limited to itraconazole based on the outcome of randomised controlled trials. It is unclear if nebulised amphotericin B deoxycholate (Fungizone<jats:sup>®</jats:sup>) is a viable therapeutic option. We evaluated the safety and efficacy of nebulised Fungizone<jats:sup>®</jats:sup> in the long‐term treatment of various forms of pulmonary aspergillosis. We assessed the records of 177 patients with various forms of pulmonary aspergillosis attending the National Aspergillosis Centre in Manchester who had received Fungizone<jats:sup>®</jats:sup>. Patients first received a challenge test with nebulised Fungizone<jats:sup>®</jats:sup> in hospital with spirometry pre/post‐Fungizone<jats:sup>®</jats:sup> and nebulised salbutamol given pre‐Fungizone<jats:sup>®</jats:sup>. Tolerability and changes in Aspergillus IgE, Aspergillus IgG and total IgE were evaluated. Sixty‐six per cent (117/177) were able to tolerate the test dose of Fungizone<jats:sup>®</jats:sup> and in all cases, the reason for discontinuation of the first test dose was worsening breathlessness. Twenty six (21%) stopped therapy within 4‐6 weeks, and the commonest reason cited for discontinuation of therapy was increased breathlessness, hoarseness and cough. Eighteen (10.2%) patients continued the Fungizone<jats:sup>®</jats:sup> for >3 months of which 5 (27.8%) recorded an improvement in total IgE, Aspergillus‐specific IgE and Aspergillus IgG. Eleven had ABPA, four had SAFS, two had Aspergillus bronchitis and one had Aspergillus sensitisation with cavitating nodules. Among these 18 patients, sputum fungal culture results went from positive to negative in five patients, became positive in one patient, remained positive in three patients, and remained negative in seven patients. Nebulised Fungizone<jats:sup>®</jats:sup> appears to be a poorly tolerated treatment for pulmonary Aspergillosis with high dropout rates. There appears to be both clinical and serological benefits following sustained treatment with nebulised Fungizone<jats:sup>®</jats:sup> in some patients.</jats:p>