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Is it Time to Give Inhaled Antibiotics Another Chance?

Ventilator-associated pneumonia (VAP) develops in as many as 27% of ventilated patients in US hospitals, and estimates suggest that it accounts for as much as half of all antibiotic use in the intensive care unit (ICU).

With so much attention being paid to reducing overall antibiotic use to combat infections caused by resistant strains, VAP is now in the crosshairs of efforts to improve delivery—and delivery methods for—treatment, and there is clearly a need for formulations designed to help ensure patients receive the correct amount of drug to the correct location. Enter inhaled antibiotics.

In a review published in the September 2017 issue of Infectious Disease Clinics (IDC), Lucy B. Palmer, MD, Associate Professor of Medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at Stony Brook University School of Medicine in New York argues that inhaled antibiotic therapy provides higher drug concentrations of antibiotics with fewer systemic side effects than IV therapy, and that recent data indicates that it may, in fact, reduce resistance. However, she acknowledges that additional multisite studies are needed to confirm this latter potential benefit and to assess their overall efficacy.

In general, the use of inhaled antibiotics in VAP has been frowned upon since a 1975 study published in the New England Journal of Medicine, in which all ICU patients were treated for their entire stay with atomized polymyxin B and, if intubated, the instilled form of the drug. This “universal administration,” Dr. Palmer writes, resulted in the development of polymyxin-resistant strains in the study patients, and thus pneumonia with 64% mortality.

“The investigators called the topical treatment a dangerous form of therapy and this led to what is now called the 40 years of fear of inhaled antibiotics,” she continues in the IDC paper. (Dr. Palmer did not respond to a request for comment from Contagion® on deadline.)

Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.