Aerosolized Antimicrobial Therapy in Acutely Ill Patients
Aerosolized Antimicrobial Therapy in Acutely Ill Patients
Recent data are sparking renewed interest in therapy with aerosolized antimicrobials in critically ill patients as well as other populations such as those with neutropenia, human immunodeficiency virus infection, and cystic fibrosis. Pneumonia is a common complication in these patients and is associated with substantial morbidity and increased mortality. Clinical trials evaluated aerosolized antimicrobials for the prevention and treatment of pneumonia in hospitalized patients. In addition, factors that affect the pulmonary deposition of aerosolized drugs in mechanically ventilated patients were identified.
Administration of aerosolized antibiotics to treat and prevent pneumonia is gaining interest. Current antimicrobial therapy of pneumonia is relatively effective, but treating these infections in the future may be difficult as bacterial resistance to conventional antibiotics increases. Systemic antibiotic therapy may be ineffective even against susceptible organisms because of issues such as immunocompetence and poor antibiotic penetration into the lungs. A potential major advantage of aerosolized antimicrobials in the treatment of pneumonia is improved efficacy compared with systemic therapy, presumably by producing very high drug concentrations at the site of infection. This same rationale can be extended to pneumonia prevention. A low occurrence of adverse drug effects and decreased development of bacterial resistance also may result because of limited systemic drug exposure.
Outpatient aerosolized pentamidine in patients with human immunodeficiency virus (HIV) infection and aminoglycosides in those with cystic fibrosis (CF) are widely administered and can positively affect patient outcomes. However, significant amounts of data also describe prevention and treatment of pneumonia in hospitalized patients with neutropenia, HIV infection, and CF. Critically ill patients also may benefit from aerosolized antimicrobial therapy. Pneumonia is the most common infection in this population and is associated with significant morbidity including longer intensive care unit (ICU) and hospital stays, and more days of mechanical ventilation, and may increase overall mortality. Major advances in providing optimal aerosol drug delivery to mechanically ventilated patients should result in greater delivery of drug to the lungs and perhaps improve efficacy.
Research articles, abstracts, and letters were identified for review by a MEDLINE search from 1966-1999. Therapy with aerosolized ribavirin for respiratory syncytial viral infection was the subject of consensus guidelines and a review and is not addressed.
Recent data are sparking renewed interest in therapy with aerosolized antimicrobials in critically ill patients as well as other populations such as those with neutropenia, human immunodeficiency virus infection, and cystic fibrosis. Pneumonia is a common complication in these patients and is associated with substantial morbidity and increased mortality. Clinical trials evaluated aerosolized antimicrobials for the prevention and treatment of pneumonia in hospitalized patients. In addition, factors that affect the pulmonary deposition of aerosolized drugs in mechanically ventilated patients were identified.
Administration of aerosolized antibiotics to treat and prevent pneumonia is gaining interest. Current antimicrobial therapy of pneumonia is relatively effective, but treating these infections in the future may be difficult as bacterial resistance to conventional antibiotics increases. Systemic antibiotic therapy may be ineffective even against susceptible organisms because of issues such as immunocompetence and poor antibiotic penetration into the lungs. A potential major advantage of aerosolized antimicrobials in the treatment of pneumonia is improved efficacy compared with systemic therapy, presumably by producing very high drug concentrations at the site of infection. This same rationale can be extended to pneumonia prevention. A low occurrence of adverse drug effects and decreased development of bacterial resistance also may result because of limited systemic drug exposure.
Outpatient aerosolized pentamidine in patients with human immunodeficiency virus (HIV) infection and aminoglycosides in those with cystic fibrosis (CF) are widely administered and can positively affect patient outcomes. However, significant amounts of data also describe prevention and treatment of pneumonia in hospitalized patients with neutropenia, HIV infection, and CF. Critically ill patients also may benefit from aerosolized antimicrobial therapy. Pneumonia is the most common infection in this population and is associated with significant morbidity including longer intensive care unit (ICU) and hospital stays, and more days of mechanical ventilation, and may increase overall mortality. Major advances in providing optimal aerosol drug delivery to mechanically ventilated patients should result in greater delivery of drug to the lungs and perhaps improve efficacy.
Research articles, abstracts, and letters were identified for review by a MEDLINE search from 1966-1999. Therapy with aerosolized ribavirin for respiratory syncytial viral infection was the subject of consensus guidelines and a review and is not addressed.
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