Terbinafina: Un nuovo farmaco antimicotico nel trattamento dell'aspergillosi polmonare : Studio pilota

Background and aim of the work. Bronchopulmonary aspergillosis is a spectrum of diseases extending from a harmless saprophytic state to rapidly fatal acute invasive conditions; their increasing frequency is due to the wide use of steroids and other immunosuppressive drugs. Conventional treatments are often ineffective and associated with side-effects. The aim of this work was to evaluate a mew allylamine antimycotic drug (terbinafine) in the treatment of lower respiratory tract mycotic infections unresponsive to conventional therapy. Methods. We report on 14 immunocompetent patients, who were unresponsive to conventional therapy or relapsed or showed untoward effects to conventional antifungal treatments. Diagnosis was based on compatible clinical history, indentification of mycotic microrganisms in biological fluids, chest x-ray and CT scan abnormalities, respiratory function test, positive skin tests and serum presence of Aspergillus precipitine. These patients were treated with terbinafine at oral doses ranging from 5 to 15 mg/kg/day for 84-264 days, depending on clinical severity of the disease, clinical course and compliance. Results. We obtained eradication of Aspergillus fumigatus (AF) in 11 patients: 3 of them obtained complete resolution of signs and symptoms; 4 a partial response with major clinical improvement and the last 4 a partial response with minor improvement. In other 3 patients, who were AF negative but with positive precipitins, we obtained one complete remission, and a clinical radiological improvement on 2 cases. Conclusion. These preliminary findings indicate that terbinafine appears to be effective in the treatment of bronchopulmonary aspergillosis in non immunocompromised patients. Controlled trials are warranted to evaluate terbinafine in pulmonary mycotic infections.