Máiz Luis, Nieto Rosa, Durán Diego, Máiz José, Ruiz-Calvo Gabriel, Muriel Alfonso, Barbero Esther, Vélez-Díaz-Pallarés Manuel, Morillo Raquel
Pneumology Department, Ramón y Cajal University Hospital, Universidad de Alcalá, Madrid, Spain.
Pneumology Department, Hospital Universitario de Getafe, Universidad Europea de Madrid, Faculty of Medicine, Health and Sports, Madrid, Spain.
Open Respir Arch. 2025 Jun 24;7(3):100460. doi: 10.1016/j.opresp.2025.100460. eCollection 2025 Jul-Sep.
The use of intravenous antibiotic formulations delivered by inhalation is controversial. Tolerance can be an issue and some treatment guidelines discourage this route of administration if the same antibiotic is available in an inhalation formulation.
This was a retrospective, observational, single-center study comparing tolerance to three antibiotics delivered by nebulization (intravenous formulations of ampicillin and gentamicin, and an inhalation formulation of colistimethate sodium) in patients with bronchial infection (BI), chronic bronchial infection (CBI), and/or recurrent respiratory infections. The study also aimed to identify factors potentially associated with tolerability.
A total of 330 antibiotic tolerance tests were performed in 135 patients (mean age 68 years; 48.9% female; mean post-bronchodilator FEV% predicted 65.9%). Of these patients, 62.2% had bronchiectasis and 39.3% had chronic obstructive pulmonary disease (COPD). The best tolerated antibiotic was colistimethate. Overall, 89.6% of colistimethate doses were tolerated, compared to 69.5% of inhaled gentamicin doses ( < 0.001) and 69.1% of ampicillin doses ( < 0.001). Compared with colistimethate administration, the odds of intolerance were 5.69 times higher for gentamicin ( < 0.001) and 6.21 times higher for ampicillin ( < 0.001). In the univariate analysis, factors that may have been associated with antibiotic intolerance included smoking habit, worse post-bronchodilator FEV% predicted and a diagnosis of COPD. In the multivariate analysis, after adjustment for antibiotic type, smoking habit, post-bronchodilator FEV and COPD diagnosis, the only factor influencing tolerance was the type of antibiotic used.
In patients with BI and/or CBI and/or recurrent respiratory infections, inhaled sodium colistimethate is significantly better tolerated than intravenous formulations of gentamicin and ampicillin for the inhalation route. The only factor influencing tolerance is the type of antibiotic used.
通过吸入方式使用静脉用抗生素制剂存在争议。耐受性可能是一个问题，并且如果有吸入制剂形式的相同抗生素，一些治疗指南不鼓励采用这种给药途径。
这是一项回顾性、观察性、单中心研究，比较了支气管感染（BI）、慢性支气管感染（CBI）和/或反复呼吸道感染患者对三种通过雾化给药的抗生素（氨苄西林和庆大霉素的静脉制剂，以及多粘菌素甲磺酸钠的吸入制剂）的耐受性。该研究还旨在确定可能与耐受性相关的因素。
共对135例患者进行了330次抗生素耐受性测试（平均年龄68岁；48.9%为女性；支气管扩张剂使用后预计FEV%平均为65.9%）。在这些患者中，62.2%患有支气管扩张，39.3%患有慢性阻塞性肺疾病（COPD）。耐受性最好的抗生素是多粘菌素甲磺酸钠。总体而言，89.6%的多粘菌素甲磺酸钠剂量可耐受，相比之下，吸入庆大霉素剂量的耐受性为69.5%（P<0.001），氨苄西林剂量的耐受性为69.1%（P<0.001）。与多粘菌素甲磺酸钠给药相比，庆大霉素不耐受的几率高5.69倍（P<0.001），氨苄西林不耐受的几率高6.21倍（P<0.001）。在单因素分析中，可能与抗生素不耐受相关的因素包括吸烟习惯、支气管扩张剂使用后预计FEV%较低以及COPD诊断。在多因素分析中，在调整抗生素类型、吸烟习惯、支气管扩张剂使用后FEV和COPD诊断后，影响耐受性的唯一因素是所用抗生素的类型。
在患有BI和/或CBI和/或反复呼吸道感染的患者中，对于吸入途径，吸入多粘菌素甲磺酸钠的耐受性明显优于庆大霉素和氨苄西林的静脉制剂。影响耐受性的唯一因素是所用抗生素的类型。
