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2016 ; 29
(3
): 581-632
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Inhaled Antibiotics for Gram-Negative Respiratory Infections
#MMPMID27226088
Wenzler E
; Fraidenburg DR
; Scardina T
; Danziger LH
Clin Microbiol Rev
2016[Jul]; 29
(3
): 581-632
PMID27226088
show ga
Gram-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 vitro and 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.