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M94A0264.TXT
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1994-10-08
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Document 0264
DOCN M94A0264
TI Treatment of invasive aspergillosis.
DT 9412
AU Denning DW; Department of Infectious Diseases and Tropical Medicine
(Monsall; Unit), North Manchester General Hospital, Crumpsall.
SO J Infect. 1994 May;28 Suppl 1:25-33. Unique Identifier : AIDSLINE
MED/94358454
AB Invasive aspergillosis is generally a life-threatening invasive
opportunistic mycosis affecting principally the upper and lower
respiratory tract. Therapeutic response rates vary considerably from one
host group to another with particularly high mortality rates in bone
marrow transplant, liver transplant and patients with aplastic anaemia
or AIDS. Only two drugs are useful for therapy, amphotericin and
itraconazole. Recent advances in the formulation of amphoterin B
(AmBisome and Amphocil) have resulted in intravenous preparations with
lower toxicity, particularly nephrotoxicity, but it has yet to be shown
that they have an increased therapeutic index for the treatment of
invasive aspergillosis. Itraconazole can only be used orally and in some
particularly high-risk or critically ill patients adequate serum
concentrations cannot be achieved. The addition of flucytosine or
rifampicin to amphotericin B therapy has, at best, only a marginal
benefit. Surgery is essential for some manifestations of invasive
aspergillosis. This article reviews therapeutic strategies including
criteria for initiation of therapy, combination and sequential therapy,
duration of therapy and secondary prophylaxis and indications for
surgery in invasive aspergillosis.
DE Amphotericin B/ANALOGS & DERIVATIVES/*THERAPEUTIC USE
Aspergillosis/*DRUG THERAPY/SURGERY AIDS-Related Opportunistic
Infections/DRUG THERAPY Cholesterol Esters/THERAPEUTIC USE Drug
Carriers Drug Therapy, Combination Flucytosine/THERAPEUTIC USE Human
Immunocompromised Host Infusions, Intravenous
Itraconazole/*THERAPEUTIC USE Liposomes Opportunistic Infections/DRUG
THERAPY Rifampin/THERAPEUTIC USE JOURNAL ARTICLE REVIEW REVIEW,
TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).