Inhaled Anti-infective Agents: Emphasis on Colistin |
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Authors: | A Michalopoulos E Papadakis |
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Institution: | (1) Department of Infectious Diseases, Infection Control, and Employee Health, Unit 402, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA; |
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Abstract: | The administration of antibiotics by the inhaled route is a widely recognized treatment in patients with cystic fibrosis (CF)
and bronchiectasis. Tobramycin solution for inhalation (TOBI) has been available for many years and is licensed in the USA
and Europe. While strong data support the use of aerosolized antibiotics for the treatment of respiratory infections in patients
with CF or bronchiectasis, only a few clinical studies have examined the role of aerosolized antibiotics in the treatment
of pneumonia, including ventilator-associated pneumonia (VAP) in these patients. During the last decade increasing interest
has been directed towards alternative treatments to the systemic administration of antimicrobial agents for the treatment
of patients with hospital-acquired pneumonia or VAP due to multidrug-resistant (MDR) Gram-negative bacteria. Recent publications
demonstrate the clinical benefits from administering inhaled aminoglycosides or polymyxins in patients with hospitalacquired
pneumonia or VAP. In addition to antibiotics, antifungals, and antivirals have been administered by inhalation to specific
groups of critically ill patients. However, randomized controlled trials dealing with the administration of anti-infective
agents via the respiratory tract are necessary in order to validate the efficacy, safety, advantages, and disadvantages of
this therapeutic approach for the treatment of nosocomial pneumonia. |
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