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Antibioterapia inhalada y dispositivos de inhalación en patología infecciosa pulmonar / Inhaled medication and inhalation devices for lung disease
Solé, Amparo; Girón, Rosa M.
Affiliation
  • Solé, Amparo; HUP La Fe. Unidad de Trasplante Pulmonar-Fibrosis Quística. Valencia. España
  • Girón, Rosa M; HU La Princesa. Unidad de Bronquiectasias-Fibrosis Quística. Madrid. España
Rev. esp. quimioter ; 28(supl.1): 19-24, sept. 2015. tab, ilus
Article in Spanish | IBECS | ID: ibc-140925
Responsible library: ES1.1
Localization: BNCS
RESUMEN
La terapia antibiótica nebulizada es una opción terapéutica muy atractiva en el tratamiento de las infecciones pulmonares dada la alta concentración que se obtiene del antimicrobiano en el sitio de la infección, minimizando efectos adversos y posibles interacciones farmacológicas. Es en la fibrosis quística (FQ) donde se han ensayado mayoritariamente estos medicamentos y dispositivos, aunque existe también experiencia en el área del trasplante pulmonar, bronquiectasias, pacientes críticos ventilados y en inmunocomprometidos principalmente oncohematológicos. La oferta de antimicrobionanos para nebulización es amplia e incluye betalactámicos, aminoglucósidos, y antifúngicos. Existe muy poca evidencia científica en esta área y prácticamente se basa en ensayos randomizados en la FQ y estudios de cohortes en otras patologías respiratorias. En esta revisión se comentan todos los antibióticos disponibles a fecha de hoy, indicaciones, resultados y dispositivos adecuados para su uso correcto. Varios factores contribuyen a su depósito pulmonar que es altamente variable en función del dispositivo empleado, fármaco, enfermedad pulmonar de base y patrón ventilatorio. Asimismo se resaltan las precauciones que se deberían tener en cuenta cuando se prescribe una terapia antibiótica nebulizada. Por último, a pesar de que muchos médicos han adquirido experiencia positiva con las terapias antibióticas nebulizadas, se necesitan ensayos clínicos fuera del campo de la FQ para responder a preguntas clínicas importantes, como lo es la dosis adecuada de antibiótico, el dispositivo de administración óptimo, así como la farmacocinética precisa del fármaco en aerosol (AU)
ABSTRACT
Nebulized antibiotic therapy is an attractive therapeutic option given the high concentration obtained from the drug at the site of infection, minimizing the adverse effects and possible drug interactions. Inhalation of drugs as treatment of cystic fibrosis (CF) related lung disease has been proven to be highly effective. Consequently, an increasing number of drugs and devices have been developed for CF lung disease or are currently under development. Other limited areas of experience in this field are lung transplant recipients, immunosuppressed patients, bronchiectasis and ventilated patients. In this review document we analyse the current status of the inhaled medications, their modes of administration and indications and their results as well as side effects. Specifically we address antibiotics, and additionally, we review the current knowledge on devices for inhalation therapy with regard to optimal particle sizes and characteristics of wet nebulisers, dry powder and metered dose inhalers. Several factors contribute to a highly variable pulmonary drug deposition as the devices, the physical properties of the administered antimicrobial agent, the type of respiratory disease and the inhalation technique. Despite many clinicians have obtained a valuable experience from the aerosolized administration of antimicrobials and persuaded of their efficacy and safety. However, RCTs out of CF are needed to answer important clinical questions, such as what is the appropriate dose, the optimal delivery device, the optimal way of drug administration, as well as the exact therapeutic role and pharmacokinetic profile of aerosolized drug (AU)
Subject(s)
Full text: Available Collection: National databases / Spain Health context: SDG3 - Health and Well-Being Health problem: Target 3.3: End transmission of communicable diseases Database: IBECS Main subject: Administration, Inhalation / Nebulizers and Vaporizers / Equipment and Supplies / Lung Diseases, Fungal Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Risk factors Language: Spanish Journal: Rev. esp. quimioter Year: 2015 Document type: Article Institution/Affiliation country: HU La Princesa/España / HUP La Fe/España
Full text: Available Collection: National databases / Spain Health context: SDG3 - Health and Well-Being Health problem: Target 3.3: End transmission of communicable diseases Database: IBECS Main subject: Administration, Inhalation / Nebulizers and Vaporizers / Equipment and Supplies / Lung Diseases, Fungal Type of study: Controlled clinical trial / Etiology study / Incidence study / Observational study / Risk factors Language: Spanish Journal: Rev. esp. quimioter Year: 2015 Document type: Article Institution/Affiliation country: HU La Princesa/España / HUP La Fe/España
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