ITRACONAZOLE FOR THE TREATMENT OF PULMONARY ASPERGILLOSIS IN HEART-TRANSPLANT RECIPIENTS

The objective of this study was to evaluate the effects of itraconazol e as a first choice drug in the treatment of pulmonary aspergillosis i n heart transplant recipients. Heart transplant recipients suffering f rom invasive pulmonary aspergillosis were included in this study. Grou p 1 included 4 patients treated with IV itraconazole (Janssen Pharmace utica) 400 mg daily, as a first choice drug for 28 d. Itraconazole was discontinued and amphotericin-B was started before the 28th day if cl inical or radiographic worsening was observed. Group 2 included 3 pati ents treated with amphotericin-B as a first choice drug. Itraconazole was discontinued in all patients of Group 1 after 12-26 d of treatment because of radiographic worsening (n = 3) or combined clinical and ra diographic worsening (n = 1). Subsequent treatment with amphotericin-B resulted in improvement of all patients. On a 5-yr follow-up period n o relapse of aspergillosis was observed in 3 of them. The fourth patie nt expired from cerebral hemorrhage. The 3 patients of Group 2 treated with amphotericin-B showed a gradual improvement, and all were doing well on a 2-yr follow-up. In conclusion, in our study population consi sted of heart transplant recipients amphotericin-B was superior to itr aconazole in the treatment of invasive pulmonary aspergillosis.