Inhaled therapeutics for prevention and treatment of pneumonia.

Safdar A, Shelburne SA, Evans SE, Dickey BF.

Expert Opin Drug Saf. 2009 Jul;8(4):435-49.

 

The lungs are the most common site of serious infection owing to their large
surface area exposed to the external environment and minimum barrier defense.
However, this architecture makes the lungs readily available for topical therapy.
Therapeutic aerosols include those directed towards improving mucociliary
clearance of pathogens, stimulation of innate resistance to microbial infection,
cytokine stimulation of immune function and delivery of antibiotics. In our
opinion inhaled antimicrobials are underused, especially in patients with
difficult-to-treat lung infections. The use of inhaled antimicrobial therapy has
become an important part of the treatment of airway infection with Pseudomonas
aeruginosa in cystic fibrosis and the prevention of invasive fungal infection in
patients undergoing heart and lung transplantation. Cytokine inhaled therapy has
also been explored in the treatment of neoplastic and infectious disease. The
choice of pulmonary drug delivery systems remains critical as air-jet and
ultrasonic nebulizer may deliver sub-optimum drug concentration if not used
properly. In future development of this field, we recommend an emphasis on the
study of the use of aerosolized hypertonic saline solution to reduce pathogen
burden in the airways of subjects infected with microbes of low virulence,
stimulation of innate resistance to prevent pneumonia in immunocompromised
subjects using cytokines or synthetic pathogen-associated molecular pattern
analogues and more opportunities for the use of inhaled antimicrobials. These
therapeutics are still in their infancy but show great promise.