Aerosolized antibiotics: do they add to the treatment of pneumonia?

Marin H Kollef, Cindy W Hamilton, A Bruce Montgomery, Marin H Kollef, Cindy W Hamilton, A Bruce Montgomery

Abstract

Purpose of review: The increasing rate of ventilator-associated pneumonia (VAP) caused by multidrug-resistant pathogens warrants the development of new treatment strategies. Carefully engineered delivery systems are undergoing evaluation to test the hypothesis that aerosolized administration of antibiotics will provide high local concentrations and fast clearance, which in turn may improve efficacy and decrease the risk of microbial resistance.

Recent findings: Recent studies indicate that aerosolized delivery systems for specially formulated antibiotics yield high local concentrations with rapid clearance and low systemic exposure. Preliminary clinical studies reveal that aerosolized delivery of antibiotics is well tolerated and active, when combined with intravenous antibiotics. No single aerosolized antibiotic is likely to provide broad-spectrum activity against both Gram-negative and Gram-positive bacteria.

Summary: Large multicenter trials are needed to determine whether preliminary findings will translate to improved clinical activity and decreased microbial resistance in VAP patients, and to optimize the use of aerosolized antibiotics.

Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
Peak amikacin concentrations in tracheal aspirates after aerosolized amikacin 50 mg/ml (with fosfomycin 20 mg/ml) by PARI Investigational eFlow Inline Nebulizer System in a phase 1, dose-escalation trial of seven patients with ventilator-associated pneumonia . The breakpoint for Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter spp. is 16 μg/ml. SD, standard deviation.
FIGURE 2
FIGURE 2
Mean peak fosfomycin concentrations in tracheal aspirates after aerosolized fosfomycin 20 mg/ml (with amikacin 50 mg/ml) by PARI Investigational eFlow Inline Nebulizer System in a phase 1, dose-escalation trial of seven patients with ventilator-associated pneumonia . The minimal inhibitory concentration for 90% (MIC90) for methicillin-resistant Staphylococcus aureus (MRSA) is 32 μg/ml. SD, standard deviation. a, The SD bar for the 2-ml dose is very small and is shown in white inside the data point.

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Source: PubMed

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