Prophylaktische Inhalation von Amphotericin B bei invasiver Aspergillose: Verteilungsstudie

Zusammenfassung

Die Prophylaxe der invasiven pulmonalen Aspergillose, die bei immunsuppri- mierten Patienten mit einer hohen Mortalität einhergeht, ist bisher unbefriedigend. Da die systemische (parenterale) Therapie mit Amphotericin B (AMB) bei nur eingeschränkter Wirksamkeit relativ viele unerwünschte Wirkungen nach sich zieht, wird in ersten Studien die inhalative Prophylaxe mit druckluftvernebeltem AMB erprobt, ohne daß bisher die intrapulmonale Verteilung von AMB untersucht worden ist. In der vorliegenden Studie wurde daher die intrapulmonale Verteilung von ^99mTc-markiertem AMB szintigraphisch untersucht und die Partikelgröße bestimmt. Es zeigte sich, daß sich AMB homogen in der Lunge verteilt, die peripheren Lungenabschnitte erreicht und mit einer Halbwertszeit von ca. 14 h ausreichend lange in der Lunge verbleibt, um antimykotisch wirksam zu sein. Somit kann die AMB-Inhalation zur Prophylaxe mit dem hier untersuchten System empfohlen werden.

Summary

Invasive pulmonary aspergillosis (IPA) during periods of immunosuppression or prolonged neutropenia is a serious condition with high mortality. Prophylaxis is unsatisfactory because of the low effectiveness of systemic administration of amphotericin B (AMB) and because of its side effects. Prophylactic inhalation of AMB by means of a nebulizing system may be able to reduce the incidence of IPA. Therefore, we studied the distribution of nebulized ^99mTc-labeled AMB and estimated its particle size. AMB is homogenously distributed in the lung and partly deposited in the terminal respiratory unit; it remains there with a half-life of at least 14 h. Therefore, prophylaxis of IPA with AMB nebulized as described can be recommended.

Schlüsselwörter

Invasive pulmonale Aspergillose - Amphotericin B - Inhalation

Key words

Invasive pulmonary aspergillosis - amphothericin B - inhalation

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