Triazole-polyene antagonism in experimental invasive pulmonary aspergillosis: in vitro and in vivo correlation

J Infect Dis. 2006 Oct 1;194(7):1008-18. doi: 10.1086/506617. Epub 2006 Aug 28.

Abstract

Combination antifungal therapy is increasingly used in the treatment of invasive aspergillosis. Whether the interaction between amphotericin B and triazoles is antagonistic against invasive aspergillosis is a controversial issue that is not likely to be resolved through a randomized clinical trial. Here, we found both in vitro and in vivo antagonism between liposomal amphotericin B and ravuconazole in simultaneous treatment of experimental invasive pulmonary aspergillosis in persistently neutropenic rabbits. Bliss independence-based drug-interaction modeling showed significant antagonism in vitro and in vivo, with the observed drug effects being 20%-69% lower than would be expected if the drugs were acting independently. These in vitro and in vivo findings of antagonism were consistent with the findings from Loewe additivity-based drug-interaction modeling. No pharmacokinetic interaction was found. The combination of a triazole and polyene may be antagonistic in the treatment of invasive pulmonary aspergillosis.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Amphotericin B / antagonists & inhibitors*
  • Amphotericin B / pharmacology
  • Amphotericin B / therapeutic use
  • Animals
  • Antifungal Agents / antagonists & inhibitors*
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use
  • Aspergillosis / drug therapy*
  • Aspergillus fumigatus / drug effects*
  • Drug Antagonism
  • Drug Therapy, Combination
  • Humans
  • Liposomes / antagonists & inhibitors*
  • Liposomes / pharmacology
  • Liposomes / therapeutic use
  • Lung Diseases, Fungal / drug therapy*
  • Microbial Sensitivity Tests
  • Models, Biological
  • Polyenes / antagonists & inhibitors
  • Polyenes / pharmacology
  • Polyenes / therapeutic use
  • Rabbits
  • Thiazoles / antagonists & inhibitors*
  • Thiazoles / pharmacology
  • Thiazoles / therapeutic use
  • Triazoles / antagonists & inhibitors*
  • Triazoles / pharmacology
  • Triazoles / therapeutic use

Substances

  • Antifungal Agents
  • Liposomes
  • Polyenes
  • Thiazoles
  • Triazoles
  • liposomal amphotericin B
  • Amphotericin B
  • ER 30346