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Pióro A, Latos M, Urlik M, Stącel T, Gawęda M, Pandel A, Przybyłowski P, Knapik P, Ochman M. Antifungal Prophylaxis and Treatment Among Lung Transplant Recipients in Early Postoperative Stage: A Single-Center Study. Transplant Proc 2022; 54:1104-1108. [DOI: 10.1016/j.transproceed.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
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Venanzi E, Martín-Dávila P, López J, Maiz L, de la Pedrosa EGG, Gioia F, Escudero R, Filigheddu E, Moreno S, Fortún J. Aerosolized Lipid Amphotericin B for Complementary Therapy and/or Secondary Prophylaxis in Patients with Invasive Pulmonary Aspergillosis: A Single-Center Experience. Mycopathologia 2019; 184:239-250. [PMID: 30903580 DOI: 10.1007/s11046-019-00331-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/14/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Experience with aerosolized lipid amphotericin B (aeLAB) as therapy or secondary prophylaxis in patients with invasive pulmonary aspergillosis (IPA) is anecdotal. METHODS We performed a single-center retrospective cohort study to evaluate the efficacy of systemic antifungal therapy with and without aeLAB in patients with proven or probable IPA. Complete or partial response at 3 months was the primary end-point. Clinical response and mortality at 12 months, occurrence of adverse drug reactions and respiratory fungal colonization were secondary end-point. RESULTS Eleven patients (39%) received aeLAB in addition to systemic antifungal therapy (group A), and 22 (61%) received systemic antifungal therapy only (group B). The use of aeLAB was not standardized. Amphotericin B lipid complex was used in all patients but one, who received liposomal amphotericin B. Five patients received aeLAB as antifungal complementary therapy and 6 received it as secondary prophylaxis. Except for the requirement of inhaled corticosteroids and home oxygen therapy, more frequent in group A, both groups were similar in baseline conditions. A better (nonsignificant) clinical outcome was observed at 3 months in patients receiving aeLAB. Only uncontrolled baseline condition was associated with one-year mortality in univariate analysis (p = 0.002). A multivariate Cox regression analysis suggests that aeLAB, corrected for uncontrolled underlying disease, reduces mortality at 12 months (HR 0.258; 95% CI 0.072-0.922; p = 0.037). CONCLUSION Although no significant difference was observed in the main variable (3-month clinical response) and in spite of methodological limitations of the study, the possible survival benefit of aeLAB, adjusted for the control of the underlying disease, could justify the performance of well-controlled studies with a greater number of patients.
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Affiliation(s)
- E Venanzi
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
| | - P Martín-Dávila
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - J López
- Hematology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - L Maiz
- Pneumology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - E Gómez-García de la Pedrosa
- Microbiology Department, Hospital Ramón y Cajal, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - F Gioia
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - R Escudero
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - E Filigheddu
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
| | - S Moreno
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain
| | - J Fortún
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Carretera Colmenar km 9,1, 28034, Madrid, Spain.
- Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
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Al Jishi Y, Rotstein C, Kumar D, Humar A, Singer LG, Keshavjee S, Husain S. Echinocandin use in lung transplant recipients. Clin Transplant 2018; 32:e13437. [PMID: 30375050 DOI: 10.1111/ctr.13437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Invasive fungal infections (IFI) are associated with significant morbidity and mortality in lung transplant recipients (LTRs). However, data outlining use of echinocandins in prophylaxis and therapy of LTRs are limited. METHOD A single-center retrospective cohort study on all LTRs from January-2010 to December-2016. Participants were screened for antifungal use to assess rate, tolerability, and clinical outcome of echinocandin use in LTRs, during the first 6 weeks of posttransplant. RESULTS A total of 777 lung transplants were reviewed in 763 LTRs. Antifungals were administered to 268 (35%) of LTRs. Reasons included preemptive antifungal therapy (55% [149/268]), targeted antifungal prophylaxis (34% [92/268]), and definitive IFI therapy (10% [27/268]). Azoles were first-line agents in 80% (215/268) of LTRs, caspofungin in 11% (30/268), micafungin in 6.7% (18/268), amphotericin B in 1.5% (4/268), and anidulafungin in 0.4% (1/268]). LTRs were started on echinocandins due to abnormal liver enzymes in 91% (46/49). Overall, 23% (50/215) of LTR's were switched off azoles. Of these, 54% (27/50) were switched to echinocandins. Switch from azoles to echinocandin was undertaken due to abnormal liver enzymes in 63% (17/27). No patients receiving first-line echinocandins were switched to other therapies due to adverse events. CONCLUSIONS Our data suggest that echinocandins are utilized in approximately 18.3% of lung transplant recipients. They are the preferred second-line agents due to a lower adverse-effect profile compared to the azoles.
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Affiliation(s)
- Yamama Al Jishi
- Department of Medicine, Division of Infectious Diseases and Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Coleman Rotstein
- Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Deepali Kumar
- Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Atul Humar
- Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Lianne G Singer
- Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Division of Respirology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute and Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shahid Husain
- Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada
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Abstract
Understanding the tissue penetration of systemically administered antifungal agents is critical for a proper appreciation of their antifungal efficacy in animals and humans. Both the time course of an antifungal drug and its absolute concentrations within tissues may differ significantly from those observed in the bloodstream. In addition, tissue concentrations must also be interpreted within the context of the pathogenesis of the various invasive fungal infections, which differ significantly. There are major technical obstacles to the estimation of concentrations of antifungal agents in various tissue subcompartments, yet these agents, even those within the same class, may exhibit markedly different tissue distributions. This review explores these issues and provides a summary of tissue concentrations of 11 currently licensed systemic antifungal agents. It also explores the therapeutic implications of their distribution at various sites of infection.
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Emery LC, Cox SK, Souza MJ. Pharmacokinetics of nebulized terbinafine in Hispaniolan Amazon parrots (Amazona ventralis). J Avian Med Surg 2012; 26:161-6. [PMID: 23156978 DOI: 10.1647/2012-003r.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aspergillosis is one of the most difficult diseases to treat successfully in avian species. Terbinafine hydrochloride offers numerous potential benefits over traditionally used antifungals for treatment of this disease. Adding nebulized antifungals to treatment strategies is thought to improve clinical outcomes in lung diseases. To determine plasma concentrations of terbinafine after nebulization, 6 adult Hispaniolan Amazon parrots were randomly divided into 2 groups of 3. Each bird was nebulized for 15 minutes with 1 of 2 terbinafine solutions, one made with a crushed tablet and the second with raw drug powder. Blood samples were collected at baseline and at multiple time points up to 720 minutes after completing nebulization. Plasma and nebulization solutions were analyzed by high-performance liquid chromatography. The terbinafine concentration of the solution made with a crushed tablet (0.87 +/- 0.05 mg/mL) was significantly lower than was that made with raw powder (1.02 +/- 0.09 mg/mL). Plasma concentrations of terbinafine did not differ significantly between birds in the 2 groups. Plasma terbinafine concentrations in birds were maintained above in vitro minimum inhibitory concentrations for approximately 1 hour in birds nebulized with the crushed tablet solution and 4 hours in birds nebulized with the raw powder solution. Higher concentrations of solution, longer nebulization periods, or more frequent administration are likely needed to reach therapeutic plasma concentrations of terbinafine for clinically relevant periods in Hispaniolan Amazon parrots.
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Affiliation(s)
- Lee C Emery
- Class of 2013, University of Tennessee College of Veterinary Medicine, 2407 River Dr, Knoxville, TN 37996, USA
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Bassetti M, Aversa F, Ballerini F, Benedetti F, Busca A, Cascavilla N, Concia E, Tendas A, Di Raimondo F, Mazza P, Nosari AM, Rossi G. Amphotericin B Lipid Complex in the Management of Invasive Fungal Infections in Immunocompromised Patients. Clin Drug Investig 2011; 31:745-58. [DOI: 10.2165/11593760-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kuiper L, Ruijgrok EJ. A review on the clinical use of inhaled amphotericin B. J Aerosol Med Pulm Drug Deliv 2009; 22:213-27. [PMID: 19466905 DOI: 10.1089/jamp.2008.0715] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Despite the systemic toxicity of amphotericin B (AMB), it still has a place in treatment or prophylactic regimes of fungal infections. METHODS A strategy for minimizing the potential of systemic side effects is to bring it in direct contact with the body site most likely to be infected, such as the administration of AMB as an aerosol. Nebulized amphotericin has been used in humans since 1959. However, due to a lack of sufficient data regarding efficacy, its use is still not established. Little is known about the optimal dose, frequency, duration of administration, and the pharmacokinetics of inhaled AMB in humans. RESULTS AND CONCLUSIONS In this review, published data regarding inhaled AMB are summarized, including available descriptions regarding preparation, dose, efficacy, and toxicity, and its place in therapy is discussed. The results from the studies that were reviewed in this article indicate that inhaled AMB may have a place in the prophylactic regimens of patients with prolonged neutropenia and in lung transplant recipients. Furthermore, nebulized (liposomal) AMB may have a place in the treatment of allergic bronchopulmonary aspergillosis (ABPA) in patients with corticosteroid-dependent ABPA.
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Affiliation(s)
- Laura Kuiper
- Department of Pharmacy, Ikazia Hospital Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Invasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate, early diagnosis and treatment are critical. This review will therefore address the most important recent advances in diagnosing, preventing and treating invasive aspergillosis in hematopoietic stem cells transplant. RECENT FINDINGS The present review will focus on therapeutic and prophylactic aspects, with particular regard to clinical use of drugs other than voriconazole (which has a well known and consolidated role for first-line therapy), combination therapy and prophylactic regimens, particularly with posaconazole. This review will also briefly deal with the clinical role of diagnostic tests such as the detection of galactomannan in body fluids other than blood, beta-D-glucan in serum and fungal DNA by PCR in body fluids. SUMMARY Galactomannan antigen detection is a rather reliable diagnostic test for invasive aspergillosis, particularly when a lower threshold of sensitivity is used. PCR is still to be validated. Liposomal amphotericin B at 3 mg/kg per day showed a similar efficacy in invasive aspergillosis as reported for voriconazole. Therapeutic drug monitoring of Aspergillus-active azoles should be implemented whenever possible in order to maximize the antifungal effect and minimize toxicity. Posaconazole showed to be active in prophylaxis, though its effectiveness in the global patient population is still controversial.
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Maschmeyer G. Invasive aspergillosis in severely immunosuppressed patients: significant progress, but many unresolved problems. Transpl Infect Dis 2008; 10:151-5. [PMID: 18489674 DOI: 10.1111/j.1399-3062.2008.00308.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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