Aspergillus in Cystic Fibrosis

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Antifungal therapies for allergic bronchopulmonary aspergillosis in people

with cystic fibrosis

Updated: 04/01/2002

from http://www.medscape.com/viewpublication/404_about " >Cochrane Review

AbstractsElphick H, Southern K

A substantive amendment to this systematic review was last made on 18 August

2000. Cochrane reviews are regularly checked and updated if necessary.

Background: Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic

reaction to colonisation of the lungs with the fungus Aspergillus fumigatus

and affects around 10% people with cystic fibrosis. ABPA is associated with

an accelerated decline in lung function. Corticosteroids, in high doses, are

the main treatment for ABPA although the long-term benefits are not clear and

their many side effects are well documented. A group of compounds, the

azoles, have activity against Aspergillus fumigatus and have been proposed as

an alternative treatment for ABPA. Of this group, Itraconazole is the most

active. A separate antifungal compound, Amphotericin B has been employed in

aerosolised form to treat invasive infection with Aspergillus fumigatus, and

may have potential for the treatment of ABPA. Antifungal therapy for ABPA in

cystic fibrosis needs to be evaluated.Objectives: The review tested the

hypotheses that antifungal interventions for the treatment of ABPA in cystic

fibrosis:

1. improve clinical status compared to placebo or standard therapy (no

placebo);

2. do not have unacceptable adverse effects.

If benefit was demonstrated, the optimal type, duration and dose of

antifungal therapy was assessed.Search strategy: We searched the Cochrane

Cystic Fibrosis and Genetic Disorders Group specialist trials register which

comprises references identified from comprehensive electronic database

searches, handsearching relevant journals and handsearching abstract books of

conference proceedings.

In addition, pharmaceutical companies were approached. Date of the most

recent search of the Group's specialised register: May 2001.Selection

criteria: Randomised controlled trials, published or unpublished, where

antifungal treatments have been compared to either placebo or no treatment,

or where different doses of the same treatment have been used in the

treatment of ABPA in patients with cystic fibrosis.Data collection and

analysis: No completed randomised controlled trials were identified.Main

results: No completed randomised controlled trials were identified.Reviewers'

conclusions: At present, there are no randomised controlled trials to

evaluate the use of antifungal therapies for the treatment of ABPA in people

with cystic fibrosis. Trials with clear outcome measures are needed to

properly evaluate this potentially useful treatment for cystic fibrosis.

Citation: Elphick H, Southern K. Antifungal therapies for allergic

bronchopulmonary aspergillosis in people with cystic fibrosis (Cochrane

Review). In: The Cochrane Library, Issue 2 2002. Oxford: Update Software.