Abstract
Background Invasive pulmonary aspergillosis (IPA) is one of the major contributing factors increasing morbidity and mortality in immunocompromized patients. Nebulized amphotericin B (AMB) has been studied as a method for prevention of IPA. However, most published studies lacked a consistent conclusion. This systematic review evaluated the efficacy and safety of prophylactic inhalation of AMB for the prevention of IPA in selected immunocompromized patients (cancer/chemotherapy, solid organ transplant lung/heart).
Methods An electronic database search was conducted including published and unpublished papers in MEDLINE and Cochrane databases together with international conference proceedings and bibliographies of major articles. Randomized control trials and observational studies (comparative/non-comparative) comparing nebulized AMB versus placebo were included. Two independent reviewers assessed and extracted the data from included studies.
Results A total of 37 studies were included in the qualitative synthesis, of which 17 were analyzed quantitatively in the meta-analysis. Incidence rates of IPA and IPA-related mortality were significantly lower with the use of prophylaxis nebulized AMB, with risk ratio (RR) 0.38 (95% CI 0.28–0.51, p<0.00001) and RR 0.54 (95% CI 0.33–0.91, p=0.02), respectively. The rates of side effects were 25% and 40% in comparative and non-comparative studies. Significant side effects promoting stopping nebulization occurred in 6.6% and 4.8%, respectively.
Conclusion This analysis found a significant protective effect of nebulized AMB in preventing IPA and IPA-related mortality in immunocompromized patients.
