Source: Annual Congress 2002 - Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU

Abstract

Inhalation of aerosolized amphotericin B is frequently used as prophylaxis against aspergillosis in neutropenic patients. The amount of drug that is delivered to the lung periphery is not known. Therefore, the peripheral lung deposition of liposomal amphotericine B from 6 nebulizer systems has been tested in-vitro. Particle size distribution and output was measured with Andersen-Impactor. Mass median aerodynamic diameter of the droplets were calculated and deposition of the drug in the peripheral lung (DEp) was determined using a semi-empirical deposition model with two different breathing pattern: inhalation volume: 600 ml; Flow rate: 260ml/s and 1000ml/s.
The following nebulizers were used: AKITA (Inamed), Pari Boy Compressor with Respigard II (Marquest Medical Products) and with LC Star (Pari), Sidestream with Portaneb Compressor (MedicAid), HaloLite (MedicAid), Aerosonic Travel (Schill).
Results:
Rate of DEp is the amount of drug that is deposited in the lung periphery per minute of treatment. The AKITA works with a breathing pattern at 200ml/sec flow and 1500ml inhalation volume, result: DEp = 55% and rate of DEp = 5.1mg/min.
Discussion: Patients should inhale slowly and deep. The peripheral lung deposition strongly depends on breathing pattern of the patients, which leads to highly variable deposition. This effect is more important than using different inhalation devices. The AKITA device controls breathing pattern and therefore has the highest and reproducible deposition.

Nebulizer	Aerosonic	HaloLite	PariLCStar	RespigardII	Sidestream
DEp (%) 260ml/s [1000ml/s]	29 [10]	33 [12]	31 [9]	28 [9]	33 [12]
Rate of DEp (mg/min) 260 ml/s [1000ml/s]	0.7 [0.2]	0.7 [0.3]	2.1 [0.7]	0.5 [0.2]	1.5 [0.5]

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Citations should be made in the following way:
K. Sommerer, T. Meyer, S. Heinecke, G. Scheuch (Gauting, Germany). In vitro lung deposition evaluation of liposomal Amphotericin B with 6 different nebulizer systems. Eur Respir J 2002; 20: Suppl. 38, 233

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