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 99/100ா, the UltraAIRா and the Aerosonicா. The reusable jet nebulizers were the Dura ProNebா, Pari-LLா and the Sidestreamா. The six disposable jet nebulizers were Marquest Acorn IIா, Hudson T Updraftா II, Baxter MistyNebா, Pari-LCா, Pari IS-2ா, and a disposable Sidestreamா. Each jet was tested with four compressors: a DeVilbiss AP-50ா, a Pulmo-Aideா, a DuraNebா and a PariMasterா. 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-Aideா and PariMasterா, 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.

Effect of Dead Volume on the Efficiency and the Cost to Deliver Medications in Cystic Fibrosis with Four Disposable Nebulizers

“…This is not the first study to illustrate the in vitro differences in nebulizer performance, but it is unique in demonstrating the impact of the V D on the efficiency of a device with regards to total nebulized drug output when the effect of evaporative losses are taken into consideration. The RF observed for the four devices is within the range reported in previous studies (14,15,19,29). Hess et al (6) reported V D data, unfortunately nebulizer specific comparisons were not possible because the data in this study were pooled for all nebulizer types for different flow and volume settings.…”

Assessment of recent nebulizer delivery systems using urinary pharmacokinetics method and aerodynamic characteristics of TOBI ® nebulized dose following inhalation

“…Nebulizer aerosol delivery is largely dependent on the nebulizer design and brand [55,56]. In this study, the effect of nebulizer design on improving tobramycin aerosol delivery has been studied by using different nebulizer delivery systems.…”

In vitro aerodynamic characterization of the dose emitted during nebulization of tobramycin high strength solution by novel and jet nebulizer delivery systems

“…The tobramycin concentration was determined by using validated HPLC method following pre-column derivatization with fluorescein isothiocyanate (FITC) [30]. The Guideline on Bioanalytical Method Validation.…”