Riveiro Vanessa, Casal Ana, Abelleira Romina, Valdés Luis
Service of Pulmonology, Hospital Clínico Universitario de Santiago de Compostela.
Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS).
Curr Opin Pulm Med. 2023 May 1;29(3):160-167. doi: 10.1097/MCP.0000000000000952. Epub 2023 Mar 3.
The incidence of bacterial respiratory tract infections is growing. In a context of increasing antibiotic resistance and lack of new classes of antibiotics, inhaled antibiotics emerge as a promising therapeutic strategy. Although they are generally used for cystic fibrosis, their use in other conditions is becoming more frequent, including no-cystic fibrosis bronchiectasis, pneumonia and mycobacterial infections.
Inhaled antibiotics exert beneficial microbiological effects in bronchiectasis and chronic bronchial infection. In nosocomial and ventilator-associated pneumonia, aerosolized antibiotics improve cure rates and bacterial eradication. In refractory Mycobacterium avium complex infections, amikacin liposome inhalation suspension is more effective in achieving long-lasting sputum conversion. In relation to biological inhaled antibiotics (antimicrobial peptides, interfering RNA and bacteriophages), currently in development, there is no still enough evidence that support their use in clinical practice.
The effective antimicrobiological activity of inhaled antibiotics, added to their potential to overcoming resistances to systemic antibiotics, make inhaled antibiotics a plausible alternative.
细菌性呼吸道感染的发病率正在上升。在抗生素耐药性增加且缺乏新型抗生素的背景下，吸入性抗生素成为一种有前景的治疗策略。尽管它们通常用于囊性纤维化，但在其他病症中的使用也越来越频繁，包括非囊性纤维化支气管扩张、肺炎和分枝杆菌感染。
吸入性抗生素在支气管扩张和慢性支气管感染中发挥有益的微生物学作用。在医院获得性肺炎和呼吸机相关性肺炎中，雾化抗生素可提高治愈率并清除细菌。在难治性鸟分枝杆菌复合群感染中，阿米卡星脂质体吸入混悬液在实现长期痰菌转阴方面更有效。关于目前正在研发的生物吸入性抗生素（抗菌肽、干扰RNA和噬菌体），目前尚无足够证据支持其在临床实践中的应用。
吸入性抗生素具有有效的抗微生物活性，加上其克服对全身用抗生素耐药性的潜力，使其成为一种合理的替代选择。
