Nebulized amphotericin B deoxycholate in management of chronic pulmonary aspergillosis: experience from a tertiary care centre in North India.

BACKGROUND

Chronic pulmonary aspergillosis (CPA) requires prolonged oral azole therapy, yet 30%-40% experience relapse after treatment discontinuation. The role of nebulized amphotericin B (NAB) in CPA as a maintenance therapy remains unexplored.

METHODS

We retrospectively reviewed CPA patients treated with NAB deoxycholate (10 mg twice daily) preparation administered either on alternate days (three times weekly) or six times weekly (6/7-day). The primary objective was to compare the efficacy and safety of these two dosage schedules in maintaining CPA remission.

RESULTS

We included 36 subjects (28 chronic cavitary pulmonary aspergillosis, 8 chronic fibrosing pulmonary aspergillosis ). Most received oral itraconazole (n = 34) for a median duration of 12 months before NAB initiation. Patients received NAB on alternate days (n = 16) or 6/7-day (n = 20) for a median duration of 11 months. Of 34 evaluable patients with a median follow-up of 27 months, remission was maintained in 23 (67.6%) during NAB therapy, with significantly higher rates with 6/7-day versus alternate-day therapy (16/19 [84.2%] versus 7/15 [46.7%]; P = 0.020). CPA relapse occurred in 11 patients (32.4%), more frequently with alternate-day treatment (8/15 [53.3%] versus 3/19 [15.8]; P = 0.020). Adverse events occurred in eight patients (22.2%), including bronchospasm (n = 5) and haemoptysis (n = 1); two discontinued NAB due to intolerance.

CONCLUSION

Nebulized amphotericin B deoxycholate maintained CPA remission in two-thirds of patients, with 6/7-day administration achieving significantly better outcomes than alternate-day therapy. Prospective randomized controlled trials are needed to establish NAB as standard maintenance therapy in CPA.