2007 OPEN FORUM Abstracts
AEROSOLIZED AMPHOTERCIN B LIPID COMPLEX (AABLC) DISTRIBUTION IN LUNG TRANSPLANT RECIPIENTS: A COMPARISON OF CONTINUOUS VERSUS BREATH ACTUATED NEBULIZERS.
E. Dodds-Ashley1, J. Davies1, N. Petry1, D. Zaas1, S. Palmer1, S. Shipes1, R. Drew1, B. Alexander1, R. Coleman1, J. Perfect1
Background: aABLC has become an attractive option for antifungal prophylaxis in immunocompromised patients. It allows localized delivery of a broad-spectrum antifungal while avoiding systemic side effects. In addition, aABLC has fewer gastrointestinal (GI) and pulmonary toxicities compared with aerosolized amphotericin B deoxycholate. Clinical data for aABLC has been obtained using a continuous delivery nebulizer. Newer, breath actuated nebulizers (BAN) may allow optimized drug delivery while minimizing environmental exposure.
Methods: A prospective, single-center open label study of aABLC distribution was conducted using 2 different nebulizers: UpDraft (Hudson RCI), a continuous nebulizer and AeroEclipse (Monahan Medical Corp), a BAN. Bilateral lung transplant recipients between 1 and 10 years following transplantation were given a single treatment of aABLC labeled with 99m Tc. A 5 minute treatment was given which was sufficient to deliver at least 1 mCi of activity at a rate of 7-8 L/min. Regional pulmonary imaging was performed immediately following treatment. Exposure was reported as % of total dose delivered (TDD) to the patient and drug delivery to right lung (RL), left lung (LL) and gastrointestinal (GI) tract (as % TDD).
Results: Ten subjects were enrolled (mean age= 48.9 years; range 26-62) and received a full treatment. Distribution as a percentage of TDD did not appear to differ between the nebulizers. On average, slightly more drug was delivered to RL (38%) compared to LL (28.5%). The continuous nebulizer resulted in 38% GI tract distribution compared with 31% with the BAN. The BAN delivered significantly more drug as a percentage of the prepared dose (average delivery= 20.7 vs. 3.4 %, p=0.01).
Conclusions: aABLC is well distributed throughout pulmonary fields by both delivery systems. Use of a breath actuated device increases the total amount of drug delivered to the patient.
*Note: Study funded by Society of Infectious Diseases Pharmacists.