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Page 13 / Case 10.03

TREATMENTS

– High anti-fungal failure rate of 36% in invasive Aspergillosis (pulmonary diseases was 56%)
– Treatment practice revealed that the Amphotercin B (AmB) alone (187) was used in most severe ICP, while itraconazole alone in 58,and a combination in 93. Patterson Thomas et al Med 2000 ( Baltimore), 2000

Amphotercin B colloidal dispersion (ABCD)
– High affinity lipid complex that consist of AmB and sodium cholestreryl sulfate, such complex decreased renal uptake compared to conventional AmB therapy.
– ABCD has an equivalent efficacy and decreased renal toxicity to Amphotercin B, in a double blind, randomized study. Bowden et al clinical inf dis 02 White et al Clinic inf dis 97

Ambisone ( liposomal AmB)
– An effective anti-fungal agent in majority of patients with invasive or superficial fungal infection O.Ringden et al, the British Soc. for anti microbial chemotherapy 91, O.Ringden et al 93,mycosis 36

Liposomal amphotericine and GCSF
– Are important in localizing the invasive form of aspergillus infection with profound immuno-suppression Hans J Dornbusch et al , Ped hematology and oncology 95

Voriconazole
– Voriconazole is efficacious in treating acute IPA. Good response was seen in 60% of IPA Temporary visual disturbance, skin rash, AND abnormal LFT were the most frequent side effects but usually does not lead to cessation of the medication. Denning et al clinical inf dis 2001
– Voriconazole led to better responses and improved survival and resulted in fewer side effects than the standard approach of the initial therapy with Amphotercin B. Raoul Herbrecht et al,the New Eng J Med 2002
– Voriconazole may be used for IPA in pediatric patients who are intolerant of or refractory to the conventional anti-fungal therapy. Walsh et al ped infect dis J 2002
– Voriconazole is an effective well tolerated treatment for refractory or less common invasive fungal infection with global response in 50%. Perfect et al clinical inf dis 2003

Caspofungin
– New therapy for the treatment of IPA in patients refractory to or intolerance to other therapy. It is an Inhibitor of fungal B-1, 3-glucan synthesis. It is inhibitory against aspergillus with overall efficacy ~45- 65%. It has an excellent safety profile Deresinki et al clinical inf dis 2003
– The anti-fungal combination of caspofungin and liposomal Amphotercin Can be administered safely to high-risk patients (refractory aspergillus pneumonia) with hematological malignancies Allff et al cancer 2003


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