Gough P A, Jordan N S
Pharmacotherapy. 1982 Nov-Dec;2(6):367-77. doi: 10.1002/j.1875-9114.1982.tb03214.x.
Achievement of sufficient concentrations of aerosolized antibiotic at the site of infection is limited by technical problems in antibiotic delivery and by drug inactivation. Antibiotic delivery by aerosolization is generally associated with minimal systemic absorption, whereas systemic absorption may be significant after endotracheal instillation. Methodologic problems make correlations between clinical response and sputum antibiotic concentrations difficult. Studies suggest that aerosolized antibiotics are of little value in the treatment of chronic bronchopulmonary infections. Endotracheal instillation appears to be associated with favorable clinical responses, possibly due to enhanced antibiotic delivery to the site of infection. Prophylactic aerosolized antibiotics are effective in altering sputum flora; reduction in mortality from acquired pneumonia has not been demonstrated. The development of resistant organisms may occur as a result of prophylactic treatment.
感染部位抗生素雾化浓度的达标受到抗生素给药技术问题及药物失活的限制。雾化给药一般全身吸收极少，而气管内滴注后全身吸收可能显著。方法学问题使得临床反应与痰液抗生素浓度之间难以建立关联。研究表明雾化抗生素在慢性支气管肺部感染治疗中价值不大。气管内滴注似乎与良好的临床反应相关，这可能是由于增强了对感染部位的抗生素递送。预防性雾化抗生素可有效改变痰液菌群；但尚未证实能降低获得性肺炎的死亡率。预防性治疗可能导致耐药菌的产生。
