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

Bassetti M, Luyt CE, Nicolau DP, Pugin J - Ann Intensive Care (2016)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy. mattba@tin.it.

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.

No MeSH data available.


Related in: MedlinePlus

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
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Fig1: 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

Mentions: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality despite advances in antimicrobial therapy [1]. Patients with severe pneumonia or critical illness often require intubation and mechanical ventilation to manage acute respiratory failure; furthermore, 9–27 % of intubated patients will develop VAP [1, 2]. In mechanically ventilated patients with VAP, attributable mortality estimates vary considerably and have been reported to range from 0 to 50 % [3, 4]; however, there are large differences between subgroups of patients, and VAP-attributable mortality may be as high as 69 % in surgical patients for example [3]. Failure to provide timely and effective therapy in the first 48 h is also linked to particularly high mortality (Fig. 1) [5]. Clearly, early initiation of appropriate antibiotics is essential for effective management.Fig. 1


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

Bassetti M, Luyt CE, Nicolau DP, Pugin J - Ann Intensive Care (2016)

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
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835402&req=5

Fig1: 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
Mentions: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remain important causes of morbidity and mortality despite advances in antimicrobial therapy [1]. Patients with severe pneumonia or critical illness often require intubation and mechanical ventilation to manage acute respiratory failure; furthermore, 9–27 % of intubated patients will develop VAP [1, 2]. In mechanically ventilated patients with VAP, attributable mortality estimates vary considerably and have been reported to range from 0 to 50 % [3, 4]; however, there are large differences between subgroups of patients, and VAP-attributable mortality may be as high as 69 % in surgical patients for example [3]. Failure to provide timely and effective therapy in the first 48 h is also linked to particularly high mortality (Fig. 1) [5]. Clearly, early initiation of appropriate antibiotics is essential for effective management.Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Infectious Diseases Clinic, Santa Maria Misericordia University Hospital, Udine, Italy. mattba@tin.it.

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.

No MeSH data available.


Related in: MedlinePlus