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Bronchitol®(mannitol) and ABPA
- Question
- Hello!
I have CF and would like to get a prescription for Bronchitol®(mannitol) in addition to my other drugs. Currently, however, I am being treated with corticosteroids and antimycotics against ABPA.
My question: is there any experience with or contradindication for using mannitol in this case? Could the sugar alcohol actually serve as "food" for the fungus in the lungs?
Many thanks! - Answer
- Dear questioner,
To answer your question, we consulted with the information department of Pharmaxis, the manufacturer of Bronchitol®. We can now provide the following answer for you:
The use Bronchitol® (mannitol) in CF patients with ABPA has not been systematically investigated by Pharmaxis; therefore we cannot give any specific recommendations on its use in this sub-group of CF patients. However, the product information does not mention APBA as a contraindication or under specific safety warnings and precautions.
Clinical studies have examined mannitol inhalation in combination with other, frequently used inhalation drugs for CF and/or the respiratory tracts. These studies showed side effects profiles similar to those common in the overall population of CF patients, and there has been no trend in the frequency of the side effects that would point to possible pharmacokinetic/pharmacodynamic responses. The analyses carried out showed that Bronchitol® can be taken in combination with the commonly used CF therapeutics, such as antibiotics, Pulmozyme®, bronchodilating drugs, and corticosteroids.
One important theoretical concern centers on the question whether inhaled mannitol possibly functions as a substrate leading to increased bacterial growth in vivo (in the patient). Mannitol does serve as a growth substrate for some bacteria in vitro (in the lab), particularly for Staphylococcus aureus and Pseudomonas aeruginosa. It can be confirmed, though, that treatment with mannitol was not associated in the studies with increased germ counts for Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophonomas maltophilia and other pathogenic germs often found in CF patients.
Kind regards
Dr. Christina Smaczny - 24.08.2012
