Wood G Christopher, Swanson Joseph M
Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Drugs. 2007;67(6):903-14. doi: 10.2165/00003495-200767060-00006.
Aerosolised administration of antibacterials remains theoretically attractive for the prevention and treatment of hospital-acquired pneumonia (HAP) because of the ability to generate high drug concentrations at the site of infection. There is renewed interest in this area because of the shortcomings of current therapies and increasing multidrug resistance in Gram-negative organisms. Clinical trials of aerosolised or endotracheally administered antibacterials for HAP prevention have generally been positive; however, early trials were hampered by the development of resistance related to indiscriminate use. More recent trials have shown efficacy at HAP prevention without adverse effects on microflora as a result of more limited usage. However, prophylactic aerosolised antibacterials still need to be studied in large randomised trials before they could enter widespread use. The treatment of HAP with aerosolised antibacterials has mostly been reported in case series without control groups. Both early reports with aminoglycosides and the more recent use of colistin have reported very good response rates; even with organisms such as Pseudomonas aeruginosa and Acinetobacter baumannii. Aerosolised antibacterials were almost always added to intravenous therapy. On the basis of these reports, the current HAP guidelines allow the addition of aerosolised antibacterials in selected patients with multidrug-resistant organisms. This seems to be a reasonable recommendation until large trials are performed. Overall, toxicity was relatively low in the publications reviewed. Aerosolised drug administration in mechanically ventilated patients requires attention to a number of factors in order to maximise drug deposition in the lung.
由于能够在感染部位产生高药物浓度，雾化吸入抗菌药物在预防和治疗医院获得性肺炎（HAP）方面在理论上仍然具有吸引力。由于目前治疗方法的缺点以及革兰氏阴性菌中多药耐药性的增加，该领域重新引起了人们的关注。雾化吸入或气管内给予抗菌药物预防HAP的临床试验总体上是积极的；然而，早期试验因与滥用相关的耐药性发展而受到阻碍。最近的试验表明，由于使用更有限，在预防HAP方面有效，且对微生物群没有不良影响。然而，预防性雾化吸入抗菌药物在广泛应用之前仍需要在大型随机试验中进行研究。雾化吸入抗菌药物治疗HAP大多在无对照组的病例系列中报道。早期使用氨基糖苷类药物的报告以及最近使用多粘菌素的报告都显示出非常好的反应率；即使是对于铜绿假单胞菌和鲍曼不动杆菌等细菌。雾化吸入抗菌药物几乎总是添加到静脉治疗中。基于这些报告，目前的HAP指南允许在选定的多药耐药菌患者中添加雾化吸入抗菌药物。在进行大型试验之前，这似乎是一个合理的建议。总体而言，在所审查的出版物中，毒性相对较低。在机械通气患者中进行雾化药物给药需要注意许多因素，以便最大限度地提高药物在肺部的沉积。
