Aerosolized Tobramycin in The Treatment of Ventilator-Associated Pneumonia: A Pilot Study

Hallal, Ali; Cohn, Stephen M.; Namias, Nicholas; Habib, Fahim; Baracco, Gio; Manning, Ronald J.; Crookes, Bruce; Schulman, Carl I.

doi:10.1089/sur.2006.051

Cited by 75 publications

(70 citation statements)

References 24 publications

(17 reference statements)

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“…Several studies, most of them with small samples, have shown good outcomes in patients with VAP due to MDRAcinetobacter spp. treated with colistin [9], high-dose ampicillin-sulbactam [10], tetracyclines [11](doxycycline or minocycline) or aerosolized tobramycin [12]. However, the recorded clinical experience with these antibiotics is still limited and the reported studies of their use in the treatment of VAP are not randomized controlled clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

et al. 2008

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Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and complicated skin and skin structure infections. Notwithstanding this, tigecycline's pharmacological and microbiological profile which includes multidrug-resistant pathogens encourages physicians' use of the drug in other infections. We analyzed, during the first months after its launch, the tigecycline prescriptions for 113 patients in 12 institutions. Twenty-five patients (22%) received tigecycline for approved indications, and 88 (78%) for "off label" indications (56% with scientific support and 22% with limited or without any scientific support). The most frequent "off label" use was ventilator associated pneumonia (VAP) (63 patients). The etiology of infections was established in 105 patients (93%). MDR-Acinetobacter spp. was the microorganism most frequently isolated (50% of the cases). Overall, attending physicians reported clinical success in 86 of the 113 patients (76%). Our study shows that the "off label" use of tigecycline is frequent, especially in VAP. due to MDRAcinetobacter spp., where the therapeutic options are limited (eg: colistin). Physicians must evaluate the benefits/ risks of using this antibiotic for indications that lack rigorous scientific support.

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Section: Discussionmentioning

confidence: 99%

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

et al. 2008

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“…Ингаляционные ан тибиотики не используются в качестве монотерапии без системных препаратов, т. к. степень их адсорб ции в кровь низка (2-4 %) и недостаточна для лече ния сопутствующих НП инфекций. Частота побоч ных эффектов (нефро и нейротоксичность) при применении ингаляционных антибиотиков невысо ка [7,[12][13][14][15][16][17][18].…”

Section: заметки из практикиunclassified

An Experience of Administration of Inhaled Tobramycin in Severe Nosocomial Pneumonia

Половников¹,

Kuzovlev²,

Ильичев³

2011

Pulʹmonologiâ (Mosk.)

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“…and inhaled tobramycin (291). Patients with clinical symptoms of VAP or a new pulmonary infiltrate on a chest radiograph after 96 h of intubation were eligible for the study.…”

Section: Nosocomial Pneumoniamentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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Aerosolized Tobramycin in The Treatment of Ventilator-Associated Pneumonia: A Pilot Study

Abstract: Aerosolized tobramycin for the treatment of VAP appeared safe and effective in this pilot study. A larger study is warranted to determine if aerosolized tobramycin will lead to better outcomes than intravenous tobramycin when used for the treatment of VAP.

Cited by 75 publications

References 24 publications

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

An Experience of Administration of Inhaled Tobramycin in Severe Nosocomial Pneumonia

Inhaled Antibiotics for Gram-Negative Respiratory Infections

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