NDLI: Meta-analysis of nebulized amphotericin B to prevent or treat pulmonary aspergillosis in immunosuppressed animals.

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Meta-analysis of nebulized amphotericin B to prevent or treat pulmonary aspergillosis in immunosuppressed animals.

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Meta-analysis of nebulized amphotericin B to prevent or treat pulmonary aspergillosis in immunosuppressed animals.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ho, K. M. Duff, O. Chambers, D. Murray, R.
Description	Country affiliation: Australia Author Affiliation: Ho KM ( Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia. kwok.ho@health.wa.gov.au)
Abstract	OBJECTIVES: Pulmonary aspergillosis in immunosuppressed patients is associated with significant mortality and morbidity. We assessed the prophylactic and therapeutic effect of nebulized amphotericin B (AmB) on mortality of immunosuppressed animals with pulmonary aspergillosis in this meta-analysis. METHODS: Literature search was based on MEDLINE (1966 to January 15, 2007), EMBASE, and Cochrane-Controlled Trials Register (2006 issue 4) databases. Only randomized-controlled studies comparing nebulized AmB with placebo on immunosuppressed animals were included. Two reviewers reviewed and extracted the data independently. RESULTS: Eight studies including 839 immunosuppressed animals were considered. The overall mortality of the immunosuppressed animals with pulmonary aspergillosis treated with nebulized AmB was reduced (69.4% versus 87.7%, odds ratio [OR] 0.12, 95% confidence interval [CI]: 0.08-0.19; P < 0.0001). The effect of nebulized AmB on mortality was more significant when the drug was administered as prophylaxis before the inoculation of Aspergillus fumigatus (OR 0.07, 95% CI: 0.03-0.12, P = 0.0001; I(2) = 0) than as a therapeutic agent (OR 0.20, 95% CI: 0.11-0.36, P < 0.0001; I(2) = 0) (ratio of the 2 ORs = 2.86, 95% CI: 1.03-6.11; P = 0.04). The effectiveness of AmB desoxycholate (OR 0.16, 0.06-0.38, P < 0.0001; I(2) = 0) and lipid-associated (liposomal, or lipid complex or colloidal dispersion) amphotericin (OR 0.11, 95% CI: 0.06-0.20, P < 0.0001; I(2) = 0) was not significantly different (ratio of the 2 ORs = 1.46, 95% CI: 0.49-4.39; P = 0.50). Three studies evaluated the potential side effects of nebulized amphotericin and showed that there was no significant renal toxicity but the amphotericin desoxycholate had some detrimental effects on pulmonary surfactant function. CONCLUSIONS: The use of nebulized amphotericin, either as a prophylactic or therapeutic agent, is effective in reducing mortality of immunosuppressed animals with pulmonary aspergillosis. A large randomized controlled trial is needed to confirm whether combining nebulized amphotericin with systemic antifungal agents will reduce mortality in immunosuppressed patients with suspected or proven pulmonary aspergillosis.
File Format	HTM / HTML
ISSN	13982273
Issue Number	3
Volume Number	10
e-ISSN	13993062
Journal	Transplant Infectious Disease
Language	English
Publisher	Wiley
Publisher Date	2008-06-01
Publisher Place	Denmark
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Transplantation Amphotericin B Administration & Dosage Antifungal Agents Aspergillosis Prevention & Control Immunosuppression Adverse Effects Lung Diseases, Fungal Animals Drug Therapy Mortality Journal Article Meta-analysis
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Transplantation

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