Aerosolised antibiotics: a critical appraisal of their use

Abstract

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.

Biopharmaceutical Characterization of Nebulized Antimicrobial Agents in Rats: 2. Colistin

“…T reatment of lung infections by administration of antimicrobial agents using the pulmonary route presents potential clinical use, since it may afford higher drug concentrations at the site of infection with a reduction of systemic exposure (1,2). Consequently, increased use of inhaled antibiotics, such as tobramycin, aztreonam, or colistin methansulfonate (CMS), has been observed to treat lung infections (3,4).…”

Biopharmaceutical Characterization of Nebulized Antimicrobial Agents in Rats: 1. Ciprofloxacin, Moxifloxacin, and Grepafloxacin

“…A erosol delivery of antimicrobial agents is receiving increasing interest, as it could provide an advantage over other routes of administration for the treatment of pulmonary infections by achieving higher drug concentrations at the infection site and lower systemic exposure and toxicity (1). Several antibiotics are administered as aerosols, including tobramycin, colistin methanesulfonate, and aztreonam (2,3), to cystic fibrosis patients (4) and to critically ill patients (5).…”

Antimicrobial prophylaxis for primary immunodeficiencies

“…In the US, the most experience is with inhaled tobramycin in CF resulting in improved pulmonary function, decreased bacterial load, and decreased hospitalizations [23]. In non-CF bronchiectasis, inhaled antibiotics may decrease the number of hospitalizations and microbial load, but not necessarily improve pulmonary function [23][24][25][26].…”