Aerosolised antimicrobial agents have been used in clinical practice since the 1950s. The main advantage of this route of administration is the targeted drug delivery to the site of infection in the lung. Exploitation of this targeted delivery can yield high concentrations at the site of infection/colonisation while minimising systemic toxicities. It is important to note that the ability of a drug to reach the target area in the lung effectively is dependent on a number of variables, including the nebuliser, patient technique, host anatomy and disease-specific factors. The most convincing data to support the use of aerosolised antimicrobials has been generated with tobramycin solution for inhalation (TOBI, Chiron Corp.) for maintenance treatment in patients with cystic fibrosis. In addition to cystic fibrosis, the use of aerosolised antimicrobials has also been studied for the treatment or prevention of a number of additional disease states including non-cystic fibrosis bronchiectasis, ventilator-associated pneumonia and prophylaxis against pulmonary fungal infections. Key studies evaluating the benefits and shortcomings of aerosolised antimicrobial agents in these areas are reviewed. Although the theory behind aerosolised administration of antibiotics seems to be sound, there are limited data available to support the routine use of this modality. Owing to the gaps still existing in our knowledge base regarding the routine use of aerosolised antibiotics, caution should be exercised when attempting to administer antimicrobials via this route in situations falling outside clearly established indications such as the treatment of patients with cystic fibrosis or Pneumocystis pneumonia.
Cystic fibrosis patients suffer increased sputum production and a notable decline in respiratory function throughout the progression of their disease. Patients are left vulnerable to respiratory colonization/infection from a number of pathogens, including Pseudomonas aeruginosa. At present, the only antibiotic formulation that is FDA approved for aerosolized delivery is tobramycin solution for inhalation (TSI). TSI allows for targeted antibiotic delivery to the lungs and is indicated for maintenance therapy in cystic fibrosis patients infected with P. aeruginosa. Studies demonstrate that cyclical treatment with TSI is associated with an increase in respiratory function and a decrease in sputum density in cystic fibrosis patients. Additional benefits include fewer hospitalizations and a decreased need for systemic antibiotics. However, because of the need for chronic administration, issues such as emergence of resistant organisms and toxicity are a potential concern and have also been evaluated. This review details the pharmacology of TSI and literature involving its use in cystic fibrosis patients.
Growing cover or winter crops and retaining crop residue on agricultural lands are considered beneficial management practices to address soil health and water quality. Remote sensing is a valuable tool to assess and map crop residue cover and cover crops. The objective of this study is to evaluate the performance of linear spectral unmixing for estimating soil cover in the non-growing season (November–May) over the Canadian Lake Erie Basin using seasonal multitemporal satellite imagery. Soil cover ground measurements and multispectral Landsat-8 imagery were acquired for two areas throughout the 2015–2016 non-growing season. Vertical soil cover photos were collected from up to 40 residue and 30 cover crop fields for each area (e.g., Elgin and Essex sites) when harvest, cloud, and snow conditions permitted. Images and data were reviewed and compiled to represent a complete coverage of the basin for three time periods (post-harvest, pre-planting, and post-planting). The correlations between field measured and satellite imagery estimated soil covers (e.g., residue and green) were evaluated by coefficient of determination (R2) and root mean square error (RMSE). Overall, spectral unmixing of satellite imagery is well suited for estimating soil cover in the non-growing season. Spectral unmixing using three-endmembers (i.e., corn residue-soil-green cover; soybean residue-soil-green cover) showed higher correlations with field measured soil cover than spectral unmixing using two- or four-endmembers. For the nine non-growing season images analyzed, the residue and green cover fractions derived from linear spectral unmixing using corn residue-soil-green cover endmembers were highly correlated with the field-measured data (mean R2 of 0.70 and 0.86, respectively). The results of this study support the use of remote sensing and spectral unmixing techniques for monitoring performance metrics for government initiatives, such as the Canada-Ontario Lake Erie Action Plan, and as input for sustainability indicators that both require knowledge about non-growing season land management over a large area.
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