The role of nebulized antibiotics in treating serious respiratory infections

The administration of a nebulized antibiotic in serious respiratory tract i nfections ensures high antibiotic concentrations at the site of infection, minimising systemic concentrations and their resultant risk of toxicity. Ne bulized antibiotics have been used for the treatment of chronic infection w ith Pseudomonas aeruginosa, particularly in cystic fibrosis, but with varia ble clinical efficacy. Antibiotic delivery by nebulization is greatly influenced by the product fo rmulation and the nebulizer. Use of intravenous formulations via a nebulize r can lead to exposure to potentially irritant or toxic additives and inapp ropriate pH or osmolality ranges, whilst the choice of nebulizer can greatl y influence the drug deposition in the airway. Tobramycin Nebulizer Solutio n (TNS) is the first specific formulation for nebulization in cystic fibros is using a designated nebulizer. The potential extrapolation of nebulized antibiotic therapy to other seriou s respiratory infections, in particular bronchiectasis and ventilator-assoc iated pneumonia, is explored in this review.