de la Rosa-Carrillo David, Suárez-Cuartín Guillermo, Sibila Oriol, Golpe Rafael, Girón Rosa-María, Martínez-García Miguel-Ángel
Respiratory Department, Hospital de la Santa Creu I Sant Pau, 08041 Barcelona, Spain.
Respiratory Department, Hospital de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain.
J Clin Med. 2023 May 20;12(10):3577. doi: 10.3390/jcm12103577.
The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics.
吸入性抗生素的使用最初几乎完全局限于囊性纤维化（CF）患者。然而，在最近几十年中，其应用范围已扩展到患有非CF支气管扩张症或慢性阻塞性肺疾病且存在潜在致病微生物引起的慢性支气管感染的患者。吸入性抗生素在感染部位可达到高浓度，这增强了它们的效果，并使其能够长期给药以战胜最具耐药性的感染，同时将可能的不良反应降至最低。已开发出吸入性干粉抗生素的新剂型，除其他优点外，还具有药物制备和给药更快的特点，并且无需清洁雾化设备。在本综述中，我们分析了允许吸入抗生素的不同类型装置的优缺点，尤其是干粉吸入器。我们描述了它们的一般特征、市场上不同的吸入器及其正确使用方法。我们分析了影响干粉药物到达下呼吸道方式的因素，以及微生物学有效性和耐药性发展风险等方面。我们回顾了关于在CF患者和非CF支气管扩张症患者中使用这类装置吸入多粘菌素和妥布霉素的科学证据。最后，我们讨论了关于新型干粉抗生素开发的文献。
