Pulmonary aspergillosis treated with inhaled amphotericin B

Zhou, Qianyi; Wen-jie, Yang; Zhao, Xue-Qun

doi:10.1016/j.ijid.2016.11.419

Cited by 4 publications

(5 citation statements)

References 2 publications

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“…Twenty-two publications, mostly case reports and case series, gathering 100 patients have reported the use of n-AmB as an adjunctive treatment for IMIs (see Supplementary Materials, Table S1 ) [ 18 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ]. Curative nebulized treatment has been used in two forms of aspergillosis, tracheobronchial (TBA) and invasive pulmonary aspergillosis (IPA), mainly in lung cancer patients or lung transplant recipients.…”

Section: Resultsmentioning

confidence: 99%

“…n-AmBd has been used in 34 patients ( Supplementary Metarials, Table S1 ). Different dosing regimens have been used, mostly 12.5 mg once or twice daily in recent studies, in combination with systemic anti-mold drugs and/or interventional bronchoscopic treatment and/or topical instillation of AmB [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Cure rates ranged between 36% and 67% in the two largest series [ 66 , 67 ].…”

Section: Resultsmentioning

confidence: 99%

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Inhaled Antifungal Agents for Treatment and Prophylaxis of Bronchopulmonary Invasive Mold Infections

et al. 2022

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Pulmonary mold infections are life-threatening diseases with high morbi-mortalities. Treatment is based on systemic antifungal agents belonging to the families of polyenes (amphotericin B) and triazoles. Despite this treatment, mortality remains high and the doses of systemic antifungals cannot be increased as they often lead to toxicity. The pulmonary aerosolization of antifungal agents can theoretically increase their concentration at the infectious site, which could improve their efficacy while limiting their systemic exposure and toxicity. However, clinical experience is poor and thus inhaled agent utilization remains unclear in term of indications, drugs, and devices. This comprehensive literature review aims to describe the pharmacokinetic behavior and the efficacy of inhaled antifungal drugs as prophylaxes and curative treatments both in animal models and humans.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Inhaled Antifungal Agents for Treatment and Prophylaxis of Bronchopulmonary Invasive Mold Infections

et al. 2022

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“…Similarities in risk factors with IAA prompted concerns for IPA that emerged early in the COVID-19 pandemic [41]. Systemic antifungal therapy remains the standard of care for the management of post-viral IPA, with the potential use of adjunct aerosolized AMB as an option [5,[42][43][44][45]. This might be especially important for post influenza aspergillosis, as Aspergillus tracheobronchitis is a common clinical manifestation of post influenza aspergillosis [46].…”

Section: Inhaled Amb As Treatment or Prophylaxis In Patients With Pos...mentioning

confidence: 99%

Clinical Uses of Inhaled Antifungals for Invasive Pulmonary Fungal Disease: Promises and Challenges

Vuong

Hammond

Kontoyiannis

2023

JoF

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The role of inhaled antifungals for prophylaxis and treatment of invasive fungal pneumonias remains undefined. Herein we summarize recent clinically relevant literature in high-risk groups such as neutropenic hematology patients, including those undergoing stem cell transplant, lung and other solid transplant recipients, and those with sequential mold lung infections secondary to viral pneumonias. Although there are several limitations of the available data, inhaled liposomal amphotericin B administered 12.5 mg twice weekly could be an alternative method of prophylaxis in neutropenic populations at high risk for invasive fungal pneumonia where systemic triazoles are not tolerated. In addition, inhaled amphotericin B has been commonly used as prophylaxis, pre-emptive, or targeted therapy for lung transplant recipients but is considered as a secondary alternative for other solid organ transplant recipients. Inhaled amphotericin B seems promising as prophylaxis in fungal pneumonias secondary to viral pneumonias, influenza, and SARS CoV-2. Data remain limited for inhaled amphotericin for adjunct treatment, but the utility is feasible.

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“…However, it is difficult to reach the minimum inhibitory concentration of this drug in the lung, with high mortality [3]. Thus, clinical studies report using those parenteral formulations of deoxycholate and liposomal AmB via the pulmonary route through nebulization [9,194,[207][208][209][210]. This route is chosen due to the fast onset of action and the lower risk of adverse effects [3,147,148,211].…”

Section: Use Of Amb Formulation For Pulmonary Deliverymentioning

confidence: 99%

Could the Lung Be a Gateway for Amphotericin B to Attack the Army of Fungi?

Patricio

Pereira²,

Sarcinelli

et al. 2022

Pharmaceutics

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Fungal diseases are a significant cause of morbidity and mortality worldwide, primarily affecting immunocompromised patients. Aspergillus, Pneumocystis, and Cryptococcus are opportunistic fungi and may cause severe lung disease. They can develop mechanisms to evade the host immune system and colonize or cause lung disease. Current fungal infection treatments constitute a few classes of antifungal drugs with significant fungi resistance development. Amphotericin B (AmB) has a broad-spectrum antifungal effect with a low incidence of resistance. However, AmB is a highly lipophilic antifungal with low solubility and permeability and is unstable in light, heat, and oxygen. Due to the difficulty of achieving adequate concentrations of AmB in the lung by intravenous administration and seeking to minimize adverse effects, nebulized AmB has been used. The pulmonary pathway has advantages such as its rapid onset of action, low metabolic activity at the site of action, ability to avoid first-pass hepatic metabolism, lower risk of adverse effects, and thin thickness of the alveolar epithelium. This paper presented different strategies for pulmonary AmB delivery, detailing the potential of nanoformulation and hoping to foster research in the field. Our finds indicate that despite an optimistic scenario for the pulmonary formulation of AmB based on the encouraging results discussed here, there is still no product registration on the FDA nor any clinical trial undergoing ClinicalTrial.gov.

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Pulmonary aspergillosis treated with inhaled amphotericin B

Cited by 4 publications

References 2 publications

Inhaled Antifungal Agents for Treatment and Prophylaxis of Bronchopulmonary Invasive Mold Infections

Inhaled Antifungal Agents for Treatment and Prophylaxis of Bronchopulmonary Invasive Mold Infections

Clinical Uses of Inhaled Antifungals for Invasive Pulmonary Fungal Disease: Promises and Challenges

Could the Lung Be a Gateway for Amphotericin B to Attack the Army of Fungi?

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