Gf. Schiraldi et al., TERBINAFINE IN THE TREATMENT OF NONIMMUNOCOMPROMISED COMPASSIONATE CASES OF BRONCHOPULMONARY ASPERGILLOSIS, Mycoses, 39(1-2), 1996, pp. 5-12
Conventional treatments of bronchopulmonary aspergillosis are often in
effective and result in associated side-effects. Terbinafine (a new al
lylamine derivative), although as active against Aspergillus in vitro
as amphotericin B and itraconazole, is less effective in rodent models
because of a rapid hepatic first-pass effect. As terbinafine is metab
olized differently in humans, the aim of this work was to evaluate thi
s drug, for the first time, in the treatment of seven immunocompetent
patients with lower respiratory tract mycotic infections unresponsive
to the usual antimycotic drugs. Diagnosis was based on identification
of fungal isolates, worsening of respiratory function tests, chest rad
iographs and computerized tomographic (CT) scan changes, positive skin
test, aspergillin precipitins and clinical history. Terbinafine was a
dministered at doses ranging from 5 to 15 mg kg(-1) day(-1) depending
on the clinical severity of the disease, and was given for 90-270 days
depending on clinical progress and compliance. In three patients A. f
umigatus was suppressed with resolution of signs and symptoms; four pa
tients showed transitory A. fumigatus suppression with marked clinical
and radiological improvement. During relapses no resistance to terbin
afine was observed. No significant side-effects were detected. Terbina
fine appeared to be as effective as amphotericin B and itraconazole in
the treatment of bronchopulmonary aspergillosis in nonimmunocompromis
ed patients. These preliminary results suggest that controlled studies
are warranted.