Table 107Summary of included studies for antimicrobials for chronic pulmonary infection with A fumigatus

StudyIntervention/ComparisonPopulationOutcomesComments
Cochrane systematic reviews
Elphick 2014
Cochrane SR		Intervention
Antifungal treatments, including major treatments such as oral azoles and nebulised amphotericin
Comparison
No treatment, placebo or different dosages		Children and adults with cystic fibrosis and allergic bronchopulmonary aspergillosis.No studies were identified for inclusion in this review
Additional primary studies
Aaron 2012
(Canada)
RCT		Intervention
Itraconazole capsules daily dose of 5 mg/kg once daily; if the dose exceeded 200 mg/day it was given twice daily
Comparison
Placebo		N=35
People with cystic fibrosis ≥ 6 years of age and chronically colonised with A Fumigatus (defined as at least 2 positive sputum cultures within the last 12 months)
  • Lung function, measured as FEV1% predicted at 24 and 48 weeks
  • Time to next pulmonary exacerbation
  • proxy outcomes:
    • number of patients that experienced pulmonary exacerbations requiring oral or IV AB
    • number of patients that experienced pulmonary exacerbations requiring hospitalization
  • Quality of life, measured with the tool CFQ-R at 24 weeks
  • Adverse events, reported during the 24-week study duration
Not reported:
  • Eradication of the specified organism from sputum/airway cultures
  • Nutritional status
  • Emergence of resistant organisms/antibiotic resistance
(+) low risk of bias for sequence generation, blinding and selective reporting
(+) first prospective RCT
(+) ITT analysis
(?) unclear risk of bias for allocation concealment
(-) pilot study small sample size, authors failed to recruit more patients to extend the study
(-) Failure to achieve therapeutic levels of Itraconazole in many patients

From: 9, Pulmonary monitoring, assessment and management

Cover of Cystic Fibrosis
Cystic Fibrosis: Diagnosis and management.
NICE Guideline, No. 78.
National Guideline Alliance (UK).
Copyright © NICE 2017.

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