Endobronchial Miconazole for Pulmonary Aspergilloma

Hamamoto, Tsuneo; Watanabe, Kazuyoshi; Ikemoto, Hideo

doi:10.7326/0003-4819-98-6-1030_1

Cited by 30 publications

(8 citation statements)

References 4 publications

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“…Always in the case of aspergilloma, since the end of the 1960 s [15] endobronchial administration of antimycotics has been used and references to this technique can still be found in the literature up to the beginning of the 1980 s [16], but it was never used for treating the invasive form.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients

Veltri

Anselmetti

et al. 2000

European Radiology

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The aim of this study was to evaluate the efficacy of percutaneous treatment of pulmonary lesions from invasive aspergillosis in immunocompromised patients. From 1992 to 1998, ten patients (seven men and three women; mean age 56 years) affected by hematological neoplasms (8 acute myeloid leukemias, 2 non-Hodgkin's lymphomas) and post-chemotherapy prolonged neutropenia developed pulmonary lesions from invasive aspergillosis. A total of 13 lesions (diameter 2-7 cm, median 5 cm) were treated percutaneously due to insufficiency of the high-dose i.v. therapy; under CT guidance, a median of 10 cm3 per session of a 1 mg/cm3 diluted solution of amphotericin B was injected through a fine needle (21-22 G); 45 sessions overall were performed (one to five per lesion, median four), according to the volume of the nodules, tolerance, and complications. The results were retrospectively evaluated either radiologically or clinically. Complications were cough, mild hemoptysis, and small pneumothorax and/or pleural effusion. No major complications occurred. One month after the beginning of treatment, 8 lesions completely resolved, 4 greatly improved, and 1 was not significantly reduced. In all ten patients symptoms improved (eight of ten could restart chemotherapy as scheduled). After antiblastic retreatment, 1 patient had mycotic recurrence. In our experience transthoracic topical treatment with amphotericin B of single or few lung lesions from invasive aspergillosis was effective, affording a rapid improvement of the lesions and symptoms, and allowing continuation of chemotherapy as scheduled, thereby reducing the risk of recurrences.

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment with amphotericin B of mycotic lung lesions from invasive aspergillosis: results in 10 immunocompromised patients

Veltri

Anselmetti

et al. 2000

European Radiology

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“…One case report describes the use of miconazole by endobronchial instillation for the treatment of aspergilloma [104]. A bronchocatheter was inserted into the cavity.…”

Section: Miconazolementioning

confidence: 99%

“…Much like percutaneous antifungal administration, endobronchial instillations have primarily been reported in the treatment of Aspergillus infections of the lungs [87,[101][102][103][104][105]. As with many other novel methods of antifungal administration, most of the evidence currently exists as case reports primarily with amphotericin B [87,[101][102][103]].…”

Section: Endobronchial Instillationsmentioning

confidence: 99%

Novel modes of antifungal drug administration

Arthur¹,

Drew²,

Perfect³

2004

Expert Opinion on Investigational Drugs

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Administration of antifungals by routes other than that for which the agent was designed or approved have been utilised in attempts to provide directed therapy, reduce adverse effects and improve drug penetration into selected infection sites, such as the central nervous system, lungs and peritoneum. The most widely investigated agent utilising a novel method of drug delivery is amphotericin B. Dose forms for this agent include topicals (aerosol, nasal spray, irrigations, pastes, absorbable sponges, impregnated bone cement and gelatin), oral dosage forms (solutions, suspensions, tablets and so on) and ophthalmic preparations (drops, ointments and injections). Amphotericin B has been administered by routes such as oral, endobronchial, intrathecal, intracisternal, intra-articular, intraperitoneal, ophthalmic and as an antibiotic 'line lock'. Nystatin has been administered as an aerosol, percutaneous paste and bladder washes. Azoles, such as miconazole, fluconazole, ketoconazole and posaconazole, have been administered by novel methods but to a lesser degree. Most of these reports involve miconazole. The dose forms and routes of administration for azoles have included irrigants (bladder, joint), ophthalmic preparations (eye drops, intraocular injections, ointments), impregnated bone cement, endobronchial and intrathecal administration. Finally, both methylene blue (bladder washes) and flucytosine (peritoneal lavage, ophthalmic eye drops) have also been employed. Adequate evaluations of both the safety and efficacy of these therapies are most often hindered by prior or concomitant antifungal therapies, comorbidities and the lack of controlled clinical trials. In addition, the availability of newer treatment options, which demonstrate significant improvement in drug distribution and treatment-related adverse effects make many such novel modes of administration less practical or necessary. In contrast, the inhalation of antifungal aerosols, such as amphotericin B, is rapidly becoming a viable prophylactic option.

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“…There was a clinical improvement but the evolution of the precipitins was not reported. In one patient, Hamamoto et al (1983) pushed a catheter near the aspergilloma and injected 5 to 10 ml of miconazole 8 times. The fungus ball disappeared as well as the precipitins but the authors mentioned that although the hemoptysis decreased they were not completely stopped.…”

Section: Local Treatmentmentioning

confidence: 99%