Consensus Summary of Aerosolized Antimicrobial Agents: Application of Guideline Criteria: Insights from the Society of Infectious Diseases Pharmacists

Jennifer Le, Pharm.D.; Elizabeth Dodds Ashley, Pharm.D., M.H.S.; Melinda M. Neuhauser, Pharm.D., M.P.H.; Jack Brown, Pharm.D., M.S.; Chris Gentry, Pharm.D.; Michael E. Klepser, Pharm.D., FCCP; Ann Marie Marr, Pharm.D.; Daryl Schiller, Pharm.D.; Joshua N. Schwiesow, Pharm.D., M.B.A.; Sally Tice, Pharm.D., M.H.A.; Heather L. VandenBussche, Pharm.D.; G. Christopher Wood, Pharm.D., FCCP

Disclosures

Pharmacotherapy. 2010;30(6):562-584. 

In This Article

Abstract and Introduction

Abstract

Aerosolized delivery of antimicrobial agents is an attractive option for management of pulmonary infections, as this is an ideal method of providing high local drug concentrations while minimizing systemic exposure. With the paucity of consensus regarding the safety, efficacy, and means with which to use aerosolized antimicrobials, a task force was created by the Society of Infectious Diseases Pharmacists to critically review and evaluate the literature on the use of aerosolized antiinfective agents. This article summarizes key findings and statements for preventing or treating a variety of infectious diseases, including cystic fibrosis, bronchiecstasis, hospital-acquired pneumonia, fungal infections, nontuberculosis mycobacterial infection, and Pneumocystis jiroveci pneumonia. Our intention was to provide guidance for clinicians on the use of aerosolized antibiotics through evidence-based pharmacotherapy. Further research with well-designed clinical trials is necessary to elucidate the optimal dosage and duration of therapy and, of equal importance, to appreciate the true risks associated with the use of aerosolized delivery systems.

Introduction

Aerosolized delivery of antimicrobial agents is an attractive option for management of pulmonary infections, as this is an ideal method of providing high local drug concentrations while minimizing systemic exposure. Despite the availability of aerosolized antimicrobials for decades, our knowledge on the pulmonary pharmacokinetics, efficacy, and safety of antimicrobial agents administered by this route is insufficient. Furthermore, only a few drug products for treatment or prevention of infection are specifically formulated for this route of administration.

With the paucity of consensus regarding the safety, efficacy, and means with which to use aerosolized antimicrobials, a task force was created by the Society of Infectious Diseases Pharmacists to critically review and evaluate the literature on the use of aerosolized antiinfective agents. This task force was charged with conducting a comprehensive evaluation of the literature and providing summary statements for the use of aerosolized antimicrobial agents (excluding antiviral agents) in preventing and treating a variety of infectious diseases. This article summarizes the findings and statements of the task force and is intended to provide guidance for clinicians on the use of aerosolized antibiotics through evidence-based pharmacotherapy.

The task force consisted of 23 members with diverse practice experiences in pharmacy, ranging from ambulatory care clinics and hospitals to academic institutions. The types of infection, or clinical uses, included in this review were derived from consensus among task force members and are based on the availability of literature on aerosolized therapy. For each clinical use, at least two members, including one with experience in the use of aerosolized antibiotics, were assigned to conduct a comprehensive literature search in the PubMed and Excerpta Medica databases to identify all publications between 1966 and April 2009. Members independently evaluated published articles retrieved from the literature search, secondary article citations, and abstracts from recent professional meetings before forming a consensus for all summary statements. To ensure consistency in interpreting the data and reporting the summary statements, the task force adopted the levels of recommendation and evidence as outlined in Table 1.[1,2]

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