Itraconazole for the treatment of pulmonary aspergillosis in heart transplant recipients

• Published in: Clinical transplantation Vol. 12; no. 1; p. 30
• Main Authors: Nanas, J N, Saroglou, G, Anastasiou-Nana, M I, Kostis, E B, Petrochilou-Paschou, V P, Kontoyannis, D A, Stamatelopoulos, S F, Moulopoulos, S D
• Format: Journal Article
• Language: English
• Published: Denmark 01.02.1998
• Subjects: Adult; Amphotericin B - therapeutic use; Antifungal Agents - therapeutic use; Aspergillosis - diagnostic imaging; Aspergillosis - drug therapy; Aspergillus fumigatus - isolation & purification; Heart Transplantation; Humans; Itraconazole - therapeutic use; Lung Diseases, Fungal - diagnostic imaging; Lung Diseases, Fungal - drug therapy; Microbial Sensitivity Tests; Middle Aged; Opportunistic Infections - diagnostic imaging; Opportunistic Infections - drug therapy; Radiography
• ISSN: 0902-0063
• DOI: 10.1111/j.1399-0012.1998.tb01065.x

The objective of this study was to evaluate the effects of itraconazole as a first choice drug in the treatment of pulmonary aspergillosis in heart transplant recipients. Heart transplant recipients suffering from invasive pulmonary aspergillosis were included in this study. Group 1 included 4 patients treated with i.v. itraconazole (Janssen Pharmaceutica) 400 mg daily, as a first choice drug for 28 d. Itraconazole was discontinued and amphotericin-B was started before the 28th day if clinical or radiographic worsening was observed. Group 2 included 3 patients treated with amphotericin-B as a first choice drug. Itraconazole was discontinued in all patients of Group 1 after 12-26 d of treatment because of radiographic worsening (n = 3) or combined clinical and radiographic worsening (n = 1). Subsequent treatment with amphotericin-B resulted in improvement of all patients. On a 5-yr follow-up period no relapse of aspergillosis was observed in 3 of them. The fourth patient expired from cerebral hemorrhage. The 3 patients of Group 2 treated with amphotericin-B showed a gradual improvement, and all were doing well on a 2-yr follow-up. In conclusion, in our study population consisted of heart transplant recipients amphotericin-B was superior to itraconazole in the treatment of invasive pulmonary aspergillosis.