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Original report| Volume 3, ISSUE 3, P157-160, March 1999

Amphotericin B with and without itraconazole for invasive aspergillosis: A three-year retrospective study

Open ArchiveDOI:https://doi.org/10.1016/S1201-9712(99)90038-3
Amphotericin B with and without itraconazole for invasive aspergillosis: A three-year retrospective study
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      Abstract

      Background: Treatment of invasive aspergillosis is frequently unsuccessful, so innovations in therapy are needed. Clinical studies demonstrate that itraconazole may be an effective alternative to amphotericin B. Itraconazole also has been combined with amphotericin B in animal models of aspergillosis, but this regimen produced antagonistic effects.
      Objectives: To determine the role of itraconazole in the adjunctive treatment of invasive aspergillosis.
      Methods: A review was conducted of all patients with definite or probable aspergillosis from January 1995 to December 1997 who were treated with conventional amphotericin B alone or in combination with itraconazole.
      Results: Of 21 patients, 10 received amphotericin B and 11 received the combination. The two groups of patients were comparable clinically at baseline (including similar mean APACHE III scores). Both groups received similar doses and days of amphotericin B treatment. Of the patients who received combination therapy, nine (82%) were cured or improved, and of those who received only amphotericin B, five (50%) were cured or improved.
      Conclusions: This study demonstrates that itraconazole and amphotericin B given together are not clinically antagonistic and that the promise of combination therapy for aspergillosis should be evaluated further in a randomized clinical trial.

      Keywords

      References

        • Bodey G.P.
        • Vartivarian S.
        Aspergillosis.
        Eur J Clin Microbiol Infect Dis. 1989; 8: 413-437
        • Denning D.W.
        • Follansbee S.
        • Scolaro M.
        • Norris S.
        • Edelstein H.
        • Stevens D.A.
        Pulmonary aspergillosis in acquired immunodeficiency syndrome.
        N Engl J Med. 1991; 324: 654-662
        • Wald A.
        • Leisenring W.
        • van Burik J.A.
        • Bowden R.A.
        Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation.
        J Infect Dis. 1997; 175: 1459-1466
        • Burch P.A.
        • Karp J.E.
        • Merz W.G.
        • Kullman J.E.
        • Fishman E.K.
        Favorable outcome of invasive aspergillosis in patients with acute leukemia.
        J Clin Oncol. 1987; 5: 1985-1993
        • Denning D.W.
        Therapeutic outcome in invasive aspergillosis.
        Clin Infect Dis. 1996; 23: 608-615
        • Denning D.W.
        • Stevens D.A.
        Antifungal and surgical treatment of invasive aspergillosis: review of 2121 published cases.
        Rev Infect Dis. 1990; 12: 1147-1201
        • Chryssanthou E.
        In vitro susceptibility of respiratory isolates of Aspergillus species to itraconazole and amphotericin B. Acquired resistance to itraconazole.
        Scand J Infect Dis. 1997; 29: 509-512
        • Stevens D.A.
        • Lee J.Y.
        • Hostetler J.S.
        • et al.
        Analysis of compassionate use of itraconazole therapy for invasive aspergillosis by the NIAID Mycoses Study Group criteria.
        Arch Int Med. 1997; 157: 1857-1862
        • Lebeau B.
        • Pelloux H.
        • Pinel C.
        • et al.
        Itraconazole in the treatment of aspergillosis: a study of 16 cases.
        Mycoses. 1994; 37: 171-179
        • Arroyo J.
        • Medoff G.
        • Kobayashi G.S.
        Therapy of murine aspergillosis with amphotericin B in combination with rifampin or 5-fluorocytosine.
        Antimicrob Agents Chemother. 1977; 11: 21-25
        • Polak A.
        Combination therapy of experimental candidiasis, cryptococcosis, aspergillosis, and wangiellosis in mice.
        Chemotherapy. 1987; 33: 381-395
        • Chitkara N.
        • White M.
        • Rosenberg A.
        • Sun M.
        • Armstrong D.
        Retrospective comparison of treatment with amphotericin B versus amphotericin B and rifampin for invasive aspergillosis.
        in: Presented at the Ninth International Symposium on Infections in the Immunocompromised Host, Assisi, Italy, June 23–261996
        • Schaffner A.
        • Frick P.
        The effect of ketoconazole on amphotericin B in a model of disseminated aspergillosis.
        J Infect Dis. 1985; 151: 902-910
        • Schaffner A.
        • Bohler A.
        Amphotericin B refractory aspergillosis after itraconazole: evidence of significant antagonism.
        Mycoses. 1993; 36: 421-424
        • Denning D.
        • Lee J.
        • Hostetler J.S.
        • et al.
        NIAID Mycoses Study Group multicenter trial of oral itraconazole therapy for invasive aspergillosis.
        Am J Med. 1994; 97: 135-144
        • Sirio C.A.
        • Knaus W.A.
        Triage and assessment of severity of illness.
        in: Hall J. Schmidt G. Wood L. Principles of critical care. McGraw-Hill, New York1992: 551-557
        • Gallis H.A.
        • Drew R.H.
        • Pickard W.W.
        Amphotericin B: 30 years of clinical experience.
        Rev Infect Dis. 1990; 12: 308-329
        • Daneshmend T.K.
        • Warnoch D.W.
        Clinical pharmacokinetics of systemic antifungal drugs..
        Clin Pharmacokinet. 1983; 8: 17-42

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      Publication history

      Accepted: May 7, 1999
      Received: January 28, 1999

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      DOI: https://doi.org/10.1016/S1201-9712(99)90038-3

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