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[A clinical study of fluconazole in pulmonary aspergillosis]
1Department of Respiratory Diseases, National Sanatory Tokyo Hospital.
Abstract:
Fluconazole is a novel triazole antifungal agent. Its in vitro antifungal activity against Aspergillus spp. is rather weak, but in vivo animal protection studies in mice with Aspergillus infections showed that the activity of fluconazole was about 15 times as potent as that of ketoconazole. We have studied the clinical efficacy and the safety of fluconazole given to 6 patients with chronic intractable respiratory disease, pulmonary aspergillosis, at an oral dose of 400 mg once daily for 23 days to 110 days (70 days on the average). Patients were selected from those who fulfilled 2 of the following 3 criteria: 1) those with chest X-ray evidence of fungus ball, 2) those from whom Aspergillus was continuously isolated through culture of their sputum, 3) those with evidence of serum precipitinogen against Aspergillus. Clinical efficacies were good in 2 patients out of 6 with marked contraction of fungus balls, fair in 2 with slight contraction of fungus balls or improvement of clinical symptoms, and failed in 2. Side effects and laboratory parameter abnormalities possibly considered to be related to fluconazole were not observed in any of the patients enrolled in the study, suggesting the safety in a long-term usage of the drug.
Insights
Fluconazole demonstrates clinical efficacy in treating pulmonary aspergillosis, a serious fungal infection. This study suggests fluconazole is a safe and effective treatment option for chronic respiratory diseases caused by Aspergillus.
Area of Science:
- Mycology
- Pharmacology
- Infectious Diseases
Background:
- Pulmonary aspergillosis is a severe fungal infection often complicating chronic respiratory diseases.
- Limited effective oral antifungal agents exist for long-term management.
- Fluconazole, a triazole antifungal, shows promising in vivo activity against Aspergillus species.
Purpose of the Study:
- To evaluate the clinical efficacy and safety of oral fluconazole in patients with chronic intractable respiratory disease and pulmonary aspergillosis.
- To assess the impact of fluconazole on Aspergillus-related lung pathology and symptoms.
Main Methods:
- A study involving 6 patients with confirmed pulmonary aspergillosis.
- Patients received oral fluconazole 400 mg daily for an average of 70 days (range 23-110 days).
- Inclusion criteria included radiological evidence of fungus balls, continuous Aspergillus isolation from sputum, and positive serum precipitins against Aspergillus.
Main Results:
- Good clinical efficacy was observed in 2 patients with significant fungus ball reduction.
- Fair efficacy was noted in 2 patients with partial improvement.
- Two patients did not respond to the treatment.
- No significant side effects or laboratory abnormalities were reported, indicating good safety.
Conclusions:
- Oral fluconazole shows potential as a safe and effective treatment for a subset of patients with chronic pulmonary aspergillosis.
- Further research with larger cohorts is warranted to confirm these findings and optimize treatment strategies.