Effect of nebulizer type and antibiotic concentration on device performance

Abstract

We compared the performance of selected ultrasonic and jet nebulizers when aerosolizing several antibiotic formulations to determine optimum combinations for delivery of a respirable antibiotic aerosol. Three ultrasonic devices were tested: the UltraNeb 99/100®, the UltraAIR® and the Aerosonic®. The reusable jet nebulizers were the Dura ProNeb®, Pari‐LL® and the Sidestream®. The six disposable jet nebulizers were Marquest Acorn II®, Hudson T Updraft® II, Baxter MistyNeb®, Pari‐LC®, Pari IS‐2®, and a disposable Sidestream®. Each jet was tested with four compressors: a DeVilbiss AP‐50®, a Pulmo‐Aide®, a DuraNeb® and a PariMaster®. All nebulizing systems were initially tested with normal saline. From the initial data, six jet nebulizers and one ultrasonic device were tested with varying concentrations of tobramycin, gentamicin, ceftazidime, ciprofloxacin and colistin. Output was assessed by measuring volume (milliliters per minute), and amount of drug (milligrams per minute) nebulized. We then measured mean particle size of the antibiotic aerosol with seven jet nebulizers and two different compressors, Pulmo‐Aide® and PariMaster®, and two ultrasonic devices. The rate of nebulization of saline and antibiotic solutions (milliliters per minute) was greater with the ultrasonic device(s) than all jet nebulizer systems tested. Increasing the reservoir antibiotic concentration increased the drug output (milligrams per minute) with the jet nebulizers to a maximum, followed by decreasing output. When antibiotic concentrations were increased the output decreased more precipitously with the ultrasonic devices than with the jet nebulizers. At the highest antibiotic concentrations tested, the ultrasonic devices had the lowest output. Particle size distribution was most dependent on the specific jet device, with particle size distribution less affected by a specific antibiotic or its concentration. Higher reservoir concentrations can be utilized for increasing output of respirable antibiotic aerosols by jet nebulizers. We conclude that antibiotic output is dependent upon both the nebulizing system and the reservoir concentration of antibiotic. Pediatr Pulmonol. 1997; 23:249–260. © 1997 Wiley‐Liss, Inc.

Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis: A European consensus

“…However, the total drug output levels off at a certain point: the optimal inspiratory flow rate has been found to be~15 l/min to 30 l/min, depending on the jet nebuliser used [144,165,166,[176][177][178]. Further variables are the humidity of the generating gas, temperature, concentration, viscosity, density, the physical state (solution versus suspension) and surface tension of the fluid during aerosolization [165,166,176,[179][180][181][182][183]247]. Importantly the nebuliser configuration can affect the particle size and the amount of aerosol inhaled [184].…”

“…With an identical driving airflow, the resulting output rate will differ between various jet nebulisers, as each device has its own internal resistance. Similarly, ultrasonic devices had a comparable or greater output than jet devices when comparing nebuliser output with normal saline [183]. Different methods have been applied to assess drug output rate, which can be expressed in volume (ml/min) and amount of drug (mg/min).…”

“…Different methods have been applied to assess drug output rate, which can be expressed in volume (ml/min) and amount of drug (mg/min). Methods include weighing a nebuliser [183] or measuring the change in osmolarity or concentration before and after nebulisation [178,185]. Additionally, direct measurement of the aerosol on filters can be used [248,249].…”

Alternatives to conventional suspensions for pulmonary drug delivery by nebulisers: A review

“…chloride) in a concentration greater than 31 mM and less than 300 mM. 9 Additionally, it needs to be sterile. Chemical stabilisers may also be added to provide acceptable shelf life.…”

Inhaled antimicrobial therapies for respiratory infections

“…The two most widely used types of nebulizers are jet nebulizers (most common, pressurized gas creates the aerosol) and ultrasonic nebulizers (gas or air pressure source is not required) [9][10][11][12]. Although each nebulizer type may generate particles of appropriate size, jet nebulizers may be better suited for use with inhaled antimicrobials, because they do not require the drug to be heated, thereby avoiding the risk of degradation.…”