Novel amikacin inhaled formulation for the treatment of lower respiratory tract infections.

Lower respiratory tract infections are usually treated with systemic antibiotics, but sometimes in certain conditions inhaled antibiotics may also be used. In cystic fibrosis (CF) for example, inhaled tobramycin is used to treat chronic airways infection due to Pseudomonas aeruginosa, and in other conditions such as ventilator-associated pneumonia, inhaled colistin is used as add-on therapy to reduce the risk of side effects of prolonged systemic exposure. Other inhaled antibiotics are currently under development, and inhaled amikacin is one such example. The two formulations of inhaled amikacin currently under clinical development may have two different therapeutic trajectories: the nebulized liposomal formulation is the first once-daily aminoglycoside for CF patients, whereas the free nebulized amikacin may be used in addition to systemic therapy in ventilator-associated pneumonia patients exploiting reduced systemic exposure to amikacin as a therapeutic advantage, especially in patients with renal impairment.