Aminoglycosides aerosolized

Aminoglycosides are the most widely studied class of aerosolized antibiotic therapies. Since they retain bioactivity when aerosolized and are... 

The use of antimicrobial therapies through aerosolization avoids many of the toxicities associated with systemic therapy with aminoglycosides or polypeptide agents. However, the risk for promoting antibiotic resistance is a concern. The emergence of highly resistant organisms has been reported... 

Initial experiences with aerosolized antimicrobial therapies appeared in the literature more than 50 years ago. Until the early 1990s, the quality of the evidence supporting this strategy in the management of lung infections was poor. Recently, results from well-controlled clinical trials have established a role for inhaled antibiotics, particularly aminoglycosides, as suppressive therapy for patients with cystic fibrosis. Cyclic therapy with inhaled tobramycin reduces the frequency of pulmonary exacerbations and improves lung function. 

Figure 23 Sputum aminoglycoside level ( Xg/mL) sampled from patients maintained on mechanical ventilation. The patients were receiving gentamicin (80 mg every 8 h) and clinically were in a steady state. The trough level was from sputum sampled just prior to an aerosol treatment. Following aerosol therapy, average values of gentamicin exceeded 1200 jig. (From Ref. 34.)...

Nebulization of antibiotics in cystic fibrosis has also been reviewed (162). For P-lactams, an improvement in pulmonary function was demonstrated with carbenicillin (163). For polymyxin, colistin alone (164), or in conjunction with oral ciprofloxacin (165), there was a decrease in the rate of decline in pulmonary function and in the Ifequency of P. aeruginosa recovered from respiratory tract secretions. Antibiotics of this class have been reported to cause bronchospasm and respiratory failure (166). Aminoglycosides have been administered as aerosols since 1950, and they have demonstrated improvement of pulmonary function, decreased sputum bacterial density, no ototoxicity or renal toxicity, and according to Smith and Ramsey (162), they are of clinical benefit for patients with cystic... 

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