Study conclude that adjunctive inhaled antibiotics were not associated with reduced mortality: We are not sure!

Author(s):  
Patrick M. Honore ◽  
Sebastien Redant ◽  
Timothée Stoll ◽  
Thierry Preseau ◽  
Sofie Moorthamers ◽  
...  
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2021 ◽  
Vol 23 ◽  
Author(s):  
Pamelia N. Lim ◽  
Maritza M. Cervantes ◽  
Linh K. Pham ◽  
Alissa C. Rothchild

Abstract Alveolar macrophages (AMs) are lung-resident myeloid cells that sit at the interface of the airway and lung tissue. Under homeostatic conditions, their primary function is to clear debris, dead cells and excess surfactant from the airways. They also serve as innate pulmonary sentinels for respiratory pathogens and environmental airborne particles and as regulators of pulmonary inflammation. However, they have not typically been viewed as primary therapeutic targets for respiratory diseases. Here, we discuss the role of AMs in various lung diseases, explore the potential therapeutic strategies to target these innate cells and weigh the potential risks and challenges of such therapies. Additionally, in the context of the COVID-19 pandemic, we examine the role AMs play in severe disease and the therapeutic strategies that have been harnessed to modulate their function and protect against severe lung damage. There are many novel approaches in development to target AMs, such as inhaled antibiotics, liposomal and microparticle delivery systems, and host-directed therapies, which have the potential to provide critical treatment to patients suffering from severe respiratory diseases, yet there is still much work to be done to fully understand the possible benefits and risks of such approaches.


2021 ◽  
pp. 84-92
Author(s):  
Vladimir N. Drozdov ◽  
Konstantin I. Arefev ◽  
Svetlana Y. Serebrova ◽  
Irina A. Komissarenko ◽  
Evgenia V. Shikh ◽  
...  

Inhaled antibacterial drugs have been used since the 1940s with greater or lesser effectiveness, due to the possibility of targeted delivery of drugs directly to the infection site at concentrations higher than MICs. High local concentrations of antibacterial agents expand the possibilities of treating infections caused by multiresistant strains and reduces antibiotic resistance in the population. The inhaled delivery method is characterized by a high level of safety due to the absence of systemic toxic effects, which reduces the risk of pseudomembranous colitis and other complications of antibiotic therapy. Thiamphenicol glycinate acetylcysteinate is a combined drug that includes thiamphenicol and N-acetylcysteine, which causes its antibacterial and mucolytic activity. The results of clinical studies have demonstrated the effectiveness of TGA in the treatment of acute and chronic bronchitis, chronic obstructive pulmonary disease, community-acquired pneumonia, laryngotracheitis, rhinosinusitis and other infections of the upper and lower respiratory tract. In pediatrics, the drug is used to treat bronchitis and pneumonia, especially those that cannot be treated with other antibacterial drugs, bronchiolitis, whooping cough, and cystic fibrosis. The article presents data on the effectiveness and safety of containing TGA. A wide spectrum of antibacterial actions, the ability to form high local concentrations of antibacterial and mucolytic components in the focus of infection, a low risk of serious side effects in both adults and children are noted. The topical use of the combination drug has proven to be effective not only in bringing about a pronounced clinical improvement, but also in reducing the frequency of use of systemic antibiotic therapy. The efficacy of thiamphenicol glycinate acetylcysteinate is not inferior to macrolide antibiotics.


Author(s):  
Manuel Vélez-Díaz-Pallarés ◽  
Montero-Llorente Beatriz ◽  
María Ángeles Parro-Martín ◽  
Hilario Martínez-Barros ◽  
Luís Maíz ◽  
...  
Keyword(s):  

Author(s):  
Hilary Humphreys

There is an increasing number of opportunist pathogens that may cause acute pulmonary exacerbations of cystic fibrosis as the patient cohort survives longer. However, it can often be difficult to determine if the isolation of these bacteria represents colonization or true infection. Their identification from sputum samples in the microbiology laboratory is also challenging, requires significant scientific expertise, and is assisted by new technologies such as MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). One such opportunist pathogen is Stenotrophomonas maltophilia, for which risk factors include increasing age and recent oral antibiotics, especially carbapenems. However, it is unclear if this bacterium is transmitted from patient to patient unlike with Pseudomonas aeruginosa, but all patients with cystic fibrosis should be admitted to a single room when hospitalization is required. Controversies exist regarding the optimal treatment which in the future may include a greater reliance on inhaled antibiotics.


2019 ◽  
Vol 45 (3) ◽  
Author(s):  
Barbara Riquena ◽  
Luciana de Freitas Velloso Monte ◽  
Agnaldo José Lopes ◽  
Luiz Vicente Ribeiro Ferreira da Silva-Filho ◽  
Neiva Damaceno ◽  
...  

ABSTRACT Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer’s parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers’ hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers’ contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.


2019 ◽  
Vol 7 (4) ◽  
pp. 196-197
Author(s):  
Peter Haidl

Background: Inhaled antibiotics allow the delivery of higher drug concentrations at the site of infection without the systemic adverse effects observed with the use of parenteral or oral antibiotics. These antibiotics have shown to decrease the number of exacerbations, reduce bacterial load or improve pulmonary function in several chronic respiratory conditions. Objectives: The aim of this study was to describe changes in the bacteriology of sputum in patients with chronic bronchial infection with Pseudomonas aeruginosa treated with nebulized colistin. Material and Methods: All patients with chronical infection with P. aeruginosa treated with nebulised colistin attending a day care unit during a 5-year (January 2010 to December 2014) period were included. Repeated-measures t tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalisations. Results: Treatment with colistin was associated with a decrease in the number of ambulatory exacerbations (1.87-1.1, p = 0.007), of hospital exacerbations (1.3-0.7, p = 0.010) and of length of stay (15.7-8.6 days, p = 0.005). There was no linear trend in the proportion of isolate Enterobacteriaceae, gram-positive cocci, Haemophilus influenzae or fungi. Isolation of Enterobacteriaceae within 1 year after the beginning of the treatment with nebulized colistin was associated with an increase in the number of ambulatory exacerbations (incidence rate ratio 1.99, 95% CI 1.05-3.79). Conclusions: Nebulised colistin was effective in the treatment of chronic infection with P. aeruginosa, and no significant changes in the microbiological evolution were observed. Isolation of Enterobacteriaceae within 1 year after the beginning of the treatment with nebulised colistin was associated with an increase in the number of exacerbations.


Author(s):  
Sally Spencer ◽  
Lambert M Felix ◽  
Stephen J Milan ◽  
Rebecca Normansell ◽  
Pieter C Goeminne ◽  
...  
Keyword(s):  

2020 ◽  
Vol 20 (3) ◽  
pp. 265-266
Author(s):  
Daniel A Sweeney ◽  
Andre C Kalil
Keyword(s):  

2019 ◽  
Vol 5 (3) ◽  
pp. 00149-2018
Author(s):  
Maximilian Eckerland ◽  
Claudia Bock ◽  
Margarete Olivier ◽  
Leopold Pichlmaier ◽  
Mathis Steindor ◽  
...  

BackgroundIn patients with severe neurological impairment, recurrent respiratory tract infections frequently occur as a result of impaired clearance of airway secretions and microbial airway colonisation. We hypothesised that inhaled antibiotic therapy may improve the morbidity of these patients.MethodsA retrospective data analysis of 20 patients (11 nontracheotomised and nine tracheotomised) with neurological impairment and microbial airway colonisation was carried out at a children's university hospital. Two questionnaires that asked about the number of respiratory tract infections, antibiotic therapies and hospitalisations were distributed to the patients/caregivers: a first questionnaire representing the 12 months prior to the initiation of inhaled antibiotics and a second questionnaire describing the first 12 months under therapy.ResultsDuring the first 12 months of therapy, the frequency of respiratory tract infections among all participants was reduced from a mean of 6.8 episodes (median (interquartile range (IQR)) 6.0 (4.0–10.0) episodes) to a mean of 2.5 episodes (median (IQR) 2.0 (1.0–3.0) episodes; p<0.001). In addition, a significant decrease of systemic antibiotic therapies (mean 7.7, median (IQR) 6.0 (4.0–10.0)versus2.5, 2.5 (0.0–3.75) episodes; p<0.001) and hospitalisations (mean 3.9, median (IQR) 3.5 (1.0–5.0)versus0.9, 0.0 (0.0–1.0) episodes; p<0.001) was noted. This significant therapeutic effect could be demonstrated in a subgroup analysis in both tracheotomised and nontracheotomised subjects. The reduction of respiratory tract infections and systemic antibiotic therapies (and thus the therapeutic success) was significantly greater in the nontracheotomised group compared with the tracheotomised group.ConclusionsThe presented data suggest that inhaled antibiotics might play a role in treating recurrent respiratory tract infections in neuromuscular diseases.


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