Itraconazole as Salvage Therapy in Invasive Pulmonary Aspergillosis Occurring during Amphotericin B Therapy in Neutropenic Patients

Abstract

Amphotericin B is commonly used as prophylactic therapy in addition to broad-spectrum antibiotics in febrile neutropenic patients with leukaemia. Despite amphotericin B therapy, invasive pulmonary aspergillosis commonly occurs in such patients. This abstract reports 15 cases of invasive pulmonary aspergillosis occurring in neutropenic patients previously treated with intravenous amphotericin B, 0.89 mg/kg/day (range, 0.5-1.5 mg/kg/day) for a mean of 16.1 days (range, 5-70 days). The results are summarized in table 1. Seven patients achieved a complete haematological response with chemotherapy, and 8 patients did not achieve a complete haematological response and were considered to have progressive haematological disease. Deaths from invasive pulmonary aspergillosis occurred in 2/7 patients with a complete haematological response and in 3/8 patients with progressive haematological disease. Of 13 patients treated with itraconazole, 300-600 mg/day for a mean duration of 138 days (range, 74-225 days), 10 (77%) were improved. Among these 13 patients, the mean duration of neutropenia had a prognostic value for the outcome of itraconazole treatment failure (* p = 0.05, Mann-Whitney non-parametric test; see table 1). Itraconazole thus seems to be an effective treatment for invasive pulmonary aspergillosis in neutropenic patients, even after failure of amphotericin B.