Nebulized amphotericin B deoxycholate in management of chronic pulmonary aspergillosis: experience from a tertiary care centre in North India

BACKGROUND: Chronic pulmonary aspergillosis (CPA) requires prolonged oral azole therapy, yet 30%-40% experience relapse after treatment discontinuation. The role of nebulized amphotericin B (NAB) in CPA as a maintenance therapy remains unexplored. METHODS: We retrospectively reviewed CPA patients treated with NAB deoxycholate (10 mg twice daily) preparation administered either on alternate days (three times weekly) or six times weekly (6/7-day). The primary objective was to compare the efficacy and safety of these two dosage schedules in maintaining CPA remission. RESULTS: We included 36 subjects (28 chronic cavitary pulmonary aspergillosis, 8 chronic fibrosing pulmonary aspergillosis ). Most received oral itraconazole (n = 34) for a median duration of 12 months before NAB initiation. Patients received NAB on alternate days (n = 16) or 6/7-day (n = 20) for a median duration of 11 months. Of 34 evaluable patients with a median follow-up of 27 months, remission was maintained in 23 (67.6%) during NAB therapy, with significantly higher rates with 6/7-day versus alternate-day therapy (16/19 [84.2%] versus 7/15 [46.7%]; P = 0.020). CPA relapse occurred in 11 patients (32.4%), more frequently with alternate-day treatment (8/15 [53.3%] versus 3/19 [15.8]; P = 0.020). Adverse events occurred in eight patients (22.2%), including bronchospasm (n = 5) and haemoptysis (n = 1); two discontinued NAB due to intolerance. CONCLUSION: Nebulized amphotericin B deoxycholate maintained CPA remission in two-thirds of patients, with 6/7-day administration achieving significantly better outcomes than alternate-day therapy. Prospective randomized controlled trials are needed to establish NAB as standard maintenance therapy in CPA.