Gr T Popa University of Medicine and Pharmacy Iaşi, Pulmonary Disease University Hospital, Department of Medicine II -Pulmonary Disease, 30 Dr I Cihac Str, 700115 Iasi, Romania.
Expert Opin Drug Deliv. 2012 Mar;9(3):333-42. doi: 10.1517/17425247.2012.660480. Epub 2012 Feb 14.
Lower respiratory tract infections, due to Pseudomonas aeruginosa or Acinetobacter baumannii, are frequently encountered in patients with cystic fibrosis (CF) or in patients developing nosocomial pneumonias. Both of these conditions bear a high mortality risk and aggressive antibiotic therapy is necessary. Inhaled antibiotics might represent an effective therapeutic approach for these diseases as it has demonstrated good bactericidal efficacy and safety in both preclinical and clinical studies. This colistin formulation might be useful particularly in patients with respiratory tract infections due to multidrug-resistant Gram-negative bacteria. Its main advantages are a better safety profile with a minimal or absent risk of nephrotoxicity.
This paper discusses the available systemic formulations of colistin, with pharmacokinetic and safety profiles, followed by an overview of inhaled antibiotics in lower respiratory tract infections.
Inhaled colistin should be used selectively as monotherapy in chronic infections with P. aeruginosa in CF patients, whereas in patients with hospital/ventilator-acquired pneumonia (HAP/VAP), it should be used in a combined regimen with systemic antibiotics.
铜绿假单胞菌或鲍曼不动杆菌引起的下呼吸道感染在囊性纤维化（CF）患者或发生医院获得性肺炎的患者中经常发生。这两种情况都有很高的死亡率风险，需要积极的抗生素治疗。吸入抗生素可能是这些疾病的有效治疗方法，因为它在临床前和临床研究中都显示出了良好的杀菌效果和安全性。这种多粘菌素制剂对于由多重耐药革兰氏阴性菌引起的呼吸道感染可能特别有用。它的主要优点是安全性更好，肾毒性风险最小或不存在。
本文讨论了多粘菌素的现有全身制剂，包括药代动力学和安全性特征，然后概述了吸入抗生素在治疗下呼吸道感染中的应用。
吸入多粘菌素应作为 CF 患者铜绿假单胞菌慢性感染的单一疗法进行选择性使用，而对于医院/呼吸机获得性肺炎（HAP/VAP）患者，应与全身抗生素联合使用。
