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Review
. 2016 Dec;6(1):35.
doi: 10.1186/s13613-016-0140-x. Epub 2016 Apr 18.

Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient

Matteo Bassetti  1 , Charles-Edouard Luyt  2   3 , David P Nicolau  4 , Jérôme Pugin  5
Affiliations
Review

Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient

Matteo Bassetti et al. Ann Intensive Care. 2016 Dec.

Abstract

Gram-negative pneumonia in patients who are intubated and mechanically ventilated is associated with increased morbidity and mortality as well as higher healthcare costs compared with those who do not have the disease. Intravenous antibiotics are currently the standard of care for pneumonia; however, increasing rates of multidrug resistance and limited penetration of some classes of antimicrobials into the lungs reduce the effectiveness of this treatment option, and current clinical cure rates are variable, while recurrence rates remain high. Inhaled antibiotics may have the potential to improve outcomes in this patient population, but their use is currently restricted by a lack of specifically formulated solutions for inhalation and a limited number of devices designed for the nebulization of antibiotics. In this article, we review the challenges clinicians face in the treatment of pneumonia and discuss the characteristics that would constitute an ideal inhaled drug/device combination. We also review inhaled antibiotic options currently in development for the treatment of pneumonia in patients who are intubated and mechanically ventilated.

Keywords: Clinical cure; Gram-negative bacteria; Hospital-acquired pneumonia; Inhaled antibiotics; Multidrug resistance; Nebulizers; Systemic antibiotics; Ventilator-associated pneumonia.

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Figures

Fig. 1
Fig. 1
Mortality rates observed in patients with ventilator-associated pneumonia who received adequate, inadequate (IT-DIAT inadequate), inappropriate therapy (IT) or delayed initiation of appropriate therapy (DIAT). Adapted from Ref. [5]. Figure reproduced with permission from the European Respiratory Society who are the copyright holders for this material
Fig. 2
Fig. 2
Ideal properties of an antibiotic solution for aerosolization. Adapted from information in references [26, 27, 29]
Fig. 3
Fig. 3
Relationship between aerodynamic diameter and site of lung deposition. The optimal particle size for deposition throughout the lung (total) is 3–5 µm. Adapted from Ref. [70]. Figure reproduced with permission, the publisher for this copyrighted material is Mary Ann Libert, Inc. publishers
See this image and copyright information in PMC

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