Aerosolized Liposomal Amphotericin B: A Novel And Effective Treatment For Aspergillus Infections In Lung Transplant Recipients

Enrico Ruffini, Sergio Baldi, Daniela Libertucci, Paolo Solidoro, Paolo Di Marzio, Antonio Cavallo, Maurizio Mancuso, Daniela Robbiano, Daniela M. Cirillo

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Background: Liposomal Amphotericin B (AmBisome @) (LAB) is an alternative to desoxycholate Amphotericin B in Aspergillus infections. Although commonly employed intravenously, few reports have investigated the efficacy of aerosolized LAB in humans. We report our experience on aerosolized LAB in Aspergillus colonization and infection following lung transplantation (LTx). Methods: From December 1993 to March 2002, 80 patients received LTx for end-stage pulmonary disease. Aspergillus infections included: airways colonization, isolated tracheobronchitis, invasive aspergillosis and disseminated form. The preparation of the LAB aerosol consisted of 50 ml of AmBisome + 12 ml of sterile water: of these 5 ml were nebulized following a premedication with a beta2-agonist via metered-dose inhaler. LAB aerosol was delivered twice daily until clearance of the airways specimens. Results: Fifty-six patients were discharged from the hospital after LTx. At follow-up, there were 12 colonizations, 5 isolated tracheobronchitis, 5 invasive forms and 1 disseminated form. Aerosolized LAB was used alone as pre-emptive therapy in 9 colonizations, and in association with oral itraconazole in 3 tracheobronchitis and with intravenous LAB in 4 invasive forms. The aerosol was well-tolerated by all patients; only occasionally a vague discomfort while performing the aerosol was reported. All colonizations eventually resolved with aerosolized LAB alone, while all infections resolved with the combined therapy .Conclusions: Aerosolized LAB is an effective and well-tolerated delivery route in Aspergillus infections following LTx. It may be used alone as pre-emptive therapy in Aspergillus colonization and in association with standard antifungal therapy in other forms of Aspergillus infections.

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    • ICAAC 42nd