Intra-tracheal amikacin spray delivery in healthy mechanically ventilated piglets

Guillon, Antoine; Darrouzain, François; Heuzé-Vourc’h, Nathalie; Petitcollin, Antoine; Barc, Céline; Vecellio, Laurent; Cormier, B.; Lanotte, Philippe; Sarradin, Pierre; Dequin, Pierre‐François; Paintaud, Gilles; Ehrmann, Stéphan

doi:10.1016/j.pupt.2019.101807

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Furthermore, airway drug concentration is significantly increased when antibiotics are administered via nebulization 4 . In animal studies of healthy 8 and infected 9 lungs, drug deposition was improved when administered via nebulization compared to intravenously. In one adult study, 10 inhaled antibiotics alone were used to treat ventilator‐associated pneumonia and were associated with equal clinical cure rates compared to intravenous antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Inhaled antibiotics in children with tracheostomy tubes: A descriptive study

Gipsman

Prero

Toltzis

et al. 2022

Pediatric Pulmonology

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Introduction Respiratory tract infections (RTIs) are common in children with tracheostomy tubes. Anecdotally, inhaled antibiotics are commonly prescribed, although to date there are no studies describing their use in this patient population. The objective of this study was to assess the variability of this practice at a single tertiary care children's hospital. Methods All children admitted to our hospital with a tracheostomy tube who were prescribed inhaled antibiotics between 2013 and 2020 were included. Patient characteristics and data regarding inhaled antibiotic use were obtained retrospectively from the electronic medical record. Results A total of 424 courses of inhaled antibiotics were prescribed during the study period. 296 (69.8%) courses were prescribed to treat an acute RTI, whereas 128 (30.2%) were prescribed prophylactically to prevent RTIs. 58.9% of children with tracheostomy tubes hospitalized during the study period received at least one course of inhaled antibiotics. The most common antibiotics prescribed were tobramycin and gentamicin; several different doses were used. In 53.2% of treatment courses, inhaled antibiotics were co‐prescribed with systemic antibiotics. Therapy duration for treatment varied from 3 to 28 days. Respiratory cultures were used variably and antimicrobial susceptibility was often not taken into account when prescribing inhaled antibiotics. Conclusions Inhaled antibiotics were frequently prescribed as treatment and prophylaxis in children with tracheostomy tubes at our center, with significant variation in the prescribed antibiotic type, dose, frequency, duration, and co‐prescription with systemic antibiotics. Prospective studies are needed to define best practice regarding inhaled antibiotics in this patient population.

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Section: Discussionmentioning

confidence: 99%

Inhaled antibiotics in children with tracheostomy tubes: A descriptive study

Gipsman

Prero

Toltzis

et al. 2022

Pediatric Pulmonology

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“…Furthermore, in piglets with Escherichia coli pneumonia, a significantly lower bacterial burden was measured in those who received nebulized amikacin compared to those who received IV amikacin. 42,43 In one systematic review and meta-analysis of 12 studies of intubated adult patients with VAP, the use of nebulized antibiotics was associated with higher rates of clinical cure but not microbiological cure or decrease in mortality. 44 Eleven of the 12 studies examined the combination of inhaled and IV antibiotics versus the use of IV antibiotics alone.…”

Section: Treatment Of Tracheobronchitismentioning

confidence: 99%

“…While tracheal aspirate concentrations may not reflect drug concentrations in the lower airways, animal studies of mechanically ventilated piglets have shown that in both healthy and infected lungs, drug deposition in pulmonary parenchyma is superior when administered via nebulization compared to intravenously. Furthermore, in piglets with Escherichia coli pneumonia, a significantly lower bacterial burden was measured in those who received nebulized amikacin compared to those who received IV amikacin 42,43 …”

Section: Treatment Of Tracheobronchitismentioning

confidence: 99%

Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem

Gipsman

Prero

Toltzis

et al. 2022

Pediatric Pulmonology

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“…Intra-tracheal devices are also under investigation (44). In 10 ventilated piglets, Amikacin was administered through intravenous infusion, vibrating mesh nebulization or intratracheal spray.…”

Section: Development Of New Technologies-why It Will Be Easier To Make It Workmentioning

confidence: 99%

Inhaled antibiotics during mechanical ventilation—why it will work

Desgrouas¹,

Ehrmann²

2021

Ann Transl Med

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Inhaled antibiotics are a common therapy among patients suffering recurrent or chronic pulmonary infections. Their use is less frequent in acutely ill patients despite a strong theoretical rationale and growing evidence of their efficiency, safety and beneficial effect on reducing bacterial resistance emergence. Clinical trials of inhaled antibiotics have shown contradictory results among mechanically ventilated patients. The optimal nebulization setup, not always implemented in all trials, the difficulty to identify the population most likely to benefit and the testing of various therapeutic strategies such as adjunctive versus alternative to systemic antibiotics may explain the disparity in trial results. The present review first presents the reasons why inhaled antibiotics have to be developed and the benefits to be expected of inhaled anti-infectious therapy among mechanically ventilated patients. A second part develops the constraints of aerosolized therapies that one has to be aware of and the simple actions required during nebulization to ensure optimal delivery to the distal lung parenchyma. Positive and negative studies concerning inhaled antibiotics are compared to understand the discrepancies of their findings and conclusions. The last part presents current developments and perspective which will likely turn it into a fully successful therapeutic modality, and makes the link between inhaled antibiotics and inhaled anti-infectious therapy.

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Intra-tracheal amikacin spray delivery in healthy mechanically ventilated piglets

Cited by 6 publications

References 29 publications

Inhaled antibiotics in children with tracheostomy tubes: A descriptive study

Inhaled antibiotics in children with tracheostomy tubes: A descriptive study

Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem

Inhaled antibiotics during mechanical ventilation—why it will work

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