Home
Issues
Aim & Scope
Open Access
Indexing
Why publish with us
Contact
Editorial Board
Instructions to Authors (PDF)
Manuscript Types
Manuscript Formatting
How to submit
Preprints
Authorship & COI
Principles of Transparency Checklist
Publication Ethics and Publication Malpractice Statement
CrossMark
Data Policies
REVIEW
Aerolized antibiotics for the treatment of Ventilator Associated Pneumonia: A new era!
1
Department of Critical Care, Medical School, University of Athens, University Hospital ""Attikon"", Athens, Greece
2
Respiratory Intensive Care, St. Louis, Missouri, USA
3
Cardeas Pharma Corp, Seattle, Washington, USA
Corresponding author
George T. Dimopoulos
Critical Care Department of Critical Care Medical School, University of Athens University Hospital "Attikon", Athens, Greece 1 Rimini str, 12426
Critical Care Department of Critical Care Medical School, University of Athens University Hospital "Attikon", Athens, Greece 1 Rimini str, 12426
Pneumon 2014;27(1):87-93
KEYWORDS
ABSTRACT
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 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. 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.
CONFLICTS OF INTEREST
None
FUNDING
No
REFERENCES (25)
1.
Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002; 122:262–268.
2.
Bekaert M, Timsit JF, Vansteelandt S, et al. Attributable mortality of ventilator associated pneumonia: A reappraisal using causal analysis. Am J Respir Crit Care Med 2011; 184:1133–1139.
3.
Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009 2010. Infect Control Hosp Epidemiol 2013; 34:1–14.
4.
Kiem S, Schentag JJ. Interpretation of antibiotic concentration ratios measured in epithelial lining fluid. Antimicrob Agents Chemother 2008; 52:24–36.
5.
Ehrmann S, Roche-Campo F, Sferrazza Papa GF, et al. Aerosol therapy during mechanical ventilation: an international survey. Intensive Care Med 2013; 39:1048–1056.
6.
Ramsey BW, Pepe MS, Quan JM, et al. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. Cystic fibrosis inhaled tobramycin study group. N Engl J Med 1999; 340:23–30.12.
7.
McCoy KS, Quittner AL, Oermann CM, et al. Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosis. Am J Respir CritCare Med 2008; 178:921–928.
8.
Eschenbacher WL, Boushey HA, Sheppard D. Alteration in osmolarity of inhaled aerosols cause bronchoconstriction and cough, but absence of a permeant anion causes cough alone. Am Rev Respir Dis 1984; 129:211– 215.
9.
VanDevanter DR, Rose LM, Sprugel KH. 28-day inhalation toxicology of polymyxin E1, the major active component of colistin, in rats and dogs (poster P236). Presented at European Cystic Fibrosis Congress, June 6–9, 2001, Vienna, Austria.
10.
McCoy KS. Compounded colistimethate as possible cause of fatal acute respiratory distress syndrome. N Engl J Med 2007; 357:2310–2311.
11.
Coulthard K. Maximizing the efficacy and safety of colistimethate therapy. Pediatr Pulmon 2008; 43:193–195.
12.
Niederman MS, Chastre J, Corkery K, et al. Bay41-6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with Gram-negative pneumonia. Intensive Care Med 2012; 38:263–271.
13.
Montgomery AB, Rhomberg P, Abuan T, Jones R. Synergistic effects for a combination of amikacin and fosfomycin against selected resistant Gram negative pathogens (abstract 43023 and poster). Am J Respir Crit Care Med 2013; 187:A3236.
14.
Lu Q, Yang J, Liu Z, et al. Nebulized ceftazidime and amikacin in VAP caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med 2011;184:106–115.
15.
Sorbello A. Doripenem safety review. 2013. Available at www.fda.gov/ohrms/dockets/ac/08/slides/2008-4364s1-05-FDA .
16.
Hilas O, Ezzo DC, Jodlowski TZ. Doripenem (doribax), a new carbapenem antibacterial agent. Pharm Ther 2008; 33:134–180.
17.
Trapnell BC, McColley SA, Kissner DG, et al. Fosfomycin/tobramycin for inhalation in patients with cystic fibrosis with pseudomonas airway infection. Am J Respir Crit Care Med 2012; 185:171–178.
18.
Montgomery AB, Vallance S, Abuan T, et al. A randomized double-blind placebo-controlled dose-escalation phase 1 study of aerosolized amikacin and fosfomycin delivered via the PARI investigational eFlow Inline nebulizer system in mechanically ventilated patients (abstract 42767 and poster 42767). Am J Respir Crit Care Med 2013; 187:A3236.
19.
Miller DD, Amin MM, Palmer LB, et al. Aerosol delivery and modern mechanical ventilation: in vitro/in vivo evaluation. Am J Respir Crit Care Med 2003;168:1205–1209.
20.
Clark R, Heslet L, Abtonsen K, Donehower B. Evaluation of the disposition and safety of tobramycin solution for inhlalation in ventilator associated pneumonia or tracheobronchitis patients (poster). Presented at American Thoracic Society International Conference 2003, Seattle, WA.
21.
Abu-Salah T, Dhand R. Inhaled antibiotic therapy for ventilatorassociated tracheobronchitis and ventilator-associated pneumonia: an update. Adv Ther 2011; 28:728–747.
22.
Wood GC. Aerosolized antibiotics for treating hospital-acquired and ventilator-associated pneumonia. Expert Rev Anti Infect. Ther 2011; 9:993–1000.
23.
Arnold HM, Sawyer AM, Kollef MH. Use of adjunctive aerosolized antimicrobialtherapy in the treatment of Pseudomonas aeruginosa and Acinetobacter baumannii ventilator-associated pneumonia. Respir Care 2012; 57:1226– 1233.
24.
Lu Q, Luo R, Bodin L, et al. Efficacy of high-dose nebulized colistin in ventilator-associated pneumonia caused by multidrug resistant Pseudomonas aerugino sa and Acinetobacter baumannii. Anesthesiology 2012; 117:1335–1347.
25.
Korbila IP, Michalopoulos A, Rafailidis PI, et al. Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilator-associated pneumonia: a comparative cohort study. Clin Microbiol Infect 2010; 16:1230-1236.
| eISSN: | 1791-4914 |
| ISSN: | 1105-848X |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
