Archivos de bronconeumología
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Arch. Bronconeumol. · Jun 2011
Review[Inhaled antibiotics in the treatment of noncystic fibrosis bronchiectasis].
Inhaled antibiotics are increasingly used in patients with non-cystic fibrosis (CF) bronchiectasis. Currently, there is no formal indication for the use of this therapy in these patients as inhaled antibiotics are currently only indicated in patients with CF. Therefore, prescription in patients with non-CF bronchiectasis will continue to be based on compassionate use until scientific evidence from ongoing clinical trials becomes available. ⋯ Adverse effects are usually mild and consist of local irritation of the airway, although their frequency is greater than that in patients with CF. Currently, various clinical trials are being carried out that aim to establish the indications for inhaled antibiotic therapy in these patients. Due to its special characteristics (high local concentrations of the drug with scarce systemic adverse effects), inhaled antibiotic therapy will undoubtedly be an excellent future option for the management of bronchiectasis, as well as of many other diseases of the airways.
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Aerosolized antimicrobial agents have been used in clinical practice since the 1950s. The main advantage and aim of using this route of administration is delivery of the drug to the site of infection in the lung. Achieving this aim may produce high concentrations in the site of infection or colonization and reduce systemic toxicity to a minimum. ⋯ In addition to this indication, the use of aerosolized antimicrobials has also been studied in the treatment or prevention of a series of other diseases, including noncystic fibrosis bronchiectasis, ventilator-associated pneumonia, prophylaxis against fungal lung infections, mycobacterial lung infections and, more recently, in chronic obstructive pulmonary disease. Although the theoretical bases underlying aerosol antibiotic administration seem convincing, there is insufficient evidence to support its routine use. Due to the gaps in knowledge that persist in the routine use of aerosolized antibiotics, caution should be exercised in situations without clearly established indications for this modality, such as the treatment of patients with cystic fibrosis, bronchiectasis or Pneumocystis pneumonia.