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https://www.readbyqxmd.com/read/28874611/how-should-aerosols-be-delivered-during-invasive-mechanical-ventilation
#1
Rajiv Dhand
The delivery of aerosols to mechanically ventilated patients presents unique challenges and differs from inhaled drug delivery in spontaneously breathing patients in several respects. Successful aerosol delivery during invasive mechanical ventilation requires careful consideration of a host of factors that influence the amount of drug inhaled by the patient. Pressurized metered-dose inhalers and nebulizers (jet, ultrasonic, and vibrating mesh) are the most commonly used aerosol delivery devices in these patients, although other delivery devices, such as dry powder inhalers, soft mist inhalers, and intratracheal nebulizing catheters, could also be adapted for in-line use...
September 5, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28872662/current-options-in-aerosolised-drug-therapy-for-children-receiving-respiratory-support
#2
REVIEW
S Trend, B S von Ungern-Sternberg, S G Devadason, A Schultz, M L Everard
Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs...
September 5, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28843822/clofazimine-protects-against-mycobacterium-tuberculosis-dissemination-in-the-cns-following-an-aerosol-challenge-in-a-murine-model
#3
Sooraj Baijnath, Chivonne Moodley, Bongani Ngcobo, Sanil D Singh, Hendrik G Kruger, Per I Arvidsson, Tricia Naicker, Alexander Pym, Thavendran Govender
BACKGROUND: Tuberculosis (TB) has been the scourge of the human race for many decades, claiming countless number of lives along the way. This is further complicated by the ability of Mycobacterium tuberculosis (M.tb) to infect extra-pulmonary sites, more specifically the brain. These forms of TB are difficult to treat due to the problems associated with drug delivery across the blood brain barrier (BBB). Linezolid (LZD and clofazimine (CFZ) are two of the more promising anti-TB antibiotics in recent times...
August 23, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28826725/dry-powder-aerosols-to-co-deliver-antibiotics-and-nutrient-dispersion-compounds-for-enhanced-bacterial-biofilm-eradication
#4
S Sommerfeld Ross, S Gharse, L Sanchez, J Fiegel
The purpose of this study was to formulate a dry powder for inhalation containing a combination treatment for eradication of Pseudomonas aeruginosa bacterial biofilms. Dry powders containing an antibiotic (ciprofloxacin hydrochloride, CH) and nutrient dispersion compound (glutamic acid, GA) at a ratio determined to eliminate the biofilms were generated by spray drying. Leucine was added to the spray dried formulation to aid powder flowability. A central composite design of experiments was performed to determine the effects of solution and processing parameters on powder yield and aerodynamic properties...
October 5, 2017: International Journal of Pharmaceutics
https://www.readbyqxmd.com/read/28810628/use-of-aerosol-inhalation-treatment-with-budesonide-and-terbutaline-sulfate-on-acute-pediatric-asthmatic-bronchitis
#5
Fangfang Bian, Yue-E Wu, Chong-Lin Zhang
The use of oxygen-driven aerosol inhalation therapy with budesonide (suspension) and terbutaline sulfate for the treatment of pediatric asthmatic bronchitis was studied. Sixty pediatric patients diagnosed with asthmatic bronchitis in Xuzhou Children's Hospital during the period comprising April 2013 to December 2015 were enrolled in the study. After randomly dividing the patients into a control (conventional dexamethasone drip) and a treatment group (inhalation of budesonide with terbutaline sulfate) of 30 patients each, the symptoms were treated using antibiotics when necessary...
August 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28809501/microencapsulated-solid-lipid-nanoparticles-as-a-hybrid-platform-for-pulmonary-antibiotic-delivery
#6
Diana P Gaspar, Maria Manuela Gaspar, Carla V Eleutério, Ana Grenha, Mateo Blanco, Lídia M D Gonçalves, Pablo Taboada, António J Almeida, Carmen Remuñán-López
Solid lipid nanoparticles (SLN) containing rifabutin (RFB), with pulmonary administration purposes, were developed through a technique that avoids the use of organic solvents or sonication. To facilitate their pulmonary delivery, the RFB-loaded SLN were included in microspheres of appropriate size using suitable excipients (mannitol and trehalose) through a spray-drying technique. Confocal analysis microscopy showed that microspheres are spherical and that SLN are efficiently microencapsulated and homogeneously distributed throughout the microsphere matrices...
August 15, 2017: Molecular Pharmaceutics
https://www.readbyqxmd.com/read/28779834/inhaled-antibiotics-for-ventilator-associated-infections
#7
REVIEW
Lucy B Palmer
Multidrug-resistant organisms are creating a challenge for physicians treating the critically ill. As new antibiotics lag behind the emergence of worsening resistance, intensivists in countries with high rates of extensively drug-resistant bacteria are turning to inhaled antibiotics as adjunctive therapy. These drugs can provide high concentrations of drug in the lung that could not be achieved with intravenous antibiotics without significant systemic toxicity. This article summarizes current evidence describing the use of inhaled antibiotics for the treatment of bacterial ventilator-associated pneumonia and ventilator-associated tracheobronchitis...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28698272/mycobacterium-tuberculosis-phoy-proteins-promote-persister-formation-by-mediating-pst-senx3-regx3-phosphate-sensing
#8
Sarah B Namugenyi, Alisha M Aagesen, Sarah R Elliott, Anna D Tischler
The Mycobacterium tuberculosis phosphate-specific transport (Pst) system controls gene expression in response to phosphate availability by inhibiting the activation of the SenX3-RegX3 two-component system under phosphate-rich conditions, but the mechanism of communication between these systems is unknown. In Escherichia coli, inhibition of the two-component system PhoR-PhoB under phosphate-rich conditions requires both the Pst system and PhoU, a putative adaptor protein. E. coli PhoU is also involved in the formation of persisters, a subpopulation of phenotypically antibiotic-tolerant bacteria...
July 11, 2017: MBio
https://www.readbyqxmd.com/read/28666886/comparison-of-methods-to-evaluate-bacterial-contact-killing-materials
#9
Marieke van de Lagemaat, Arjen Grotenhuis, Betsy van de Belt-Gritter, Steven Roest, Ton J A Loontjens, Henk J Busscher, Henny C van der Mei, Yijin Ren
Cationic surfaces with alkylated quaternary-ammonium groups kill adhering bacteria upon contact by membrane disruption and are considered increasingly promising as a non-antibiotic based way to eradicate bacteria adhering to surfaces. However, reliable in vitro evaluation methods for bacterial contact-killing surfaces do not yet exist. More importantly, results of different evaluation methods are often conflicting. Therefore, we compared five methods to evaluate contact-killing surfaces. To this end, we have copolymerized quaternary-ammonium groups into diurethane dimethacrylate/glycerol dimethacrylate (UDMA/GDMA) and determined contact-killing efficacies against five different Gram-positive and Gram-negative strains...
September 1, 2017: Acta Biomaterialia
https://www.readbyqxmd.com/read/28627354/-principle-and-influence-factors-of-aerosolized-antibiotics-in-the-treatment-of-ventilator-associated-pneumonia
#10
Chang Liu, Yuting Zhang, Jianguo Li
Ventilator associated pneumonia (VAP) is a challenging complication of critical illness. Aerosolized antibiotic is an option for the management of VAP currently, as it is reported that it could increase levels of drug in alveolar without increasing systemic toxicity. The articles that focused on the aerosolized antibiotics in the treatment of VAP and its influence factors were reviewed, and it was found that to achieve maximum drug delivery efficiency and reduce the influence of nebulization method, some factors, such as ventilation modes, tidal volume, nebulizer type, should be adjusted and monitored during the treatment...
March 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28584156/role-of-axyz-transcriptional-regulator-in-overproduction-of-axyxy-oprz-multidrug-efflux-system-in-achromobacter-species-mutants-selected-by-tobramycin
#11
Julien Bador, Catherine Neuwirth, Nadège Grangier, Marie Muniz, Leslie Germé, Jérémy Bonnet, Vignesh-Guru Pillay, Catherine Llanes, Claire de Curraize, Lucie Amoureux
AxyXY-OprZ is an RND-type efflux system that confers innate aminoglycoside resistance to Achromobacter spp. We investigated here a putative TetR family transcriptional regulator encoded by the axyZ gene located upstream of axyXY-oprZ An in-frame axyZ gene deletion assay led to increased MICs of antibiotic substrates of the efflux system, including aminoglycosides, cefepime, fluoroquinolones, tetracyclines, and erythromycin, indicating that the product of axyZ negatively regulates expression of axyXY-oprZ Moreover, we identified an amino acid substitution at position 29 of AxyZ (V29G) in a clinical Achromobacter strain that occurred during the course of chronic respiratory tract colonization in a cystic fibrosis (CF) patient...
August 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28577419/a-simplified-guide-for-charged-aerosol-detection-of-non-chromophoric-compounds-analytical-method-development-and-validation-for-the-hplc-assay-of-aerosol-particle-size-distribution-for-amikacin
#12
Arianne Soliven, Imad A Haidar Ahmad, James Tam, Nani Kadrichu, Pete Challoner, Robert Markovich, Andrei Blasko
Amikacin, an aminoglycoside antibiotic lacking a UV chromophore, was developed into a drug product for delivery by inhalation. A robust method for amikacin assay analysis and aerosol particle size distribution (aPSD) determination, with comparable performance to the conventional UV detector was developed using a charged aerosol detector (CAD). The CAD approach involved more parameters for optimization than UV detection due to its sensitivity to trace impurities, non-linear response and narrow dynamic range of signal versus concentration...
September 5, 2017: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/28559466/inhaled-drug-therapy-2016-the-year-in-review
#13
REVIEW
Rajiv Dhand
Some recent salient publications related to inhaled drug therapy are discussed. Unexpectedly, a 2.5-μg once-daily dose of tiotropium (Respimat) had greater efficacy than the 5.0-μg daily dose. Occurrence of a reverse dose response serves to caution us that administering more drug is not always beneficial. Small-airway inflammation contributes to pathogenesis of asthma, especially severe asthma. However, there is no conclusive evidence that the use of small-particle aerosols to target small airways improves clinical outcomes in controlled clinical trials...
July 2017: Respiratory Care
https://www.readbyqxmd.com/read/28509852/inhaled-antibiotic-therapy-in-chronic-respiratory-diseases
#14
REVIEW
Diego J Maselli, Holly Keyt, Marcos I Restrepo
The management of patients with chronic respiratory diseases affected by difficult to treat infections has become a challenge in clinical practice. Conditions such as cystic fibrosis (CF) and non-CF bronchiectasis require extensive treatment strategies to deal with multidrug resistant pathogens that include Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, Burkholderia species and non-tuberculous Mycobacteria (NTM). These challenges prompted scientists to deliver antimicrobial agents through the pulmonary system by using inhaled, aerosolized or nebulized antibiotics...
May 16, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28485320/aerosolized-amikacin-as-adjunctive-therapy-of-ventilator-associated-pneumonia-caused-by-multidrug-resistant-gram-negative-bacteria-a-single-center-randomized-controlled-trial
#15
Chang Liu, Yu-Ting Zhang, Zhi-Yong Peng, Qing Zhou, Bo Hu, Hui Zhou, Jian-Guo Li
BACKGROUND: Aerosolized amikacin (AA) is a current option for the management of ventilator-associated pneumonia (VAP) caused by multidrug-resistant Gram-negative bacteria (MDR-GNB), as it is reported that AA could increase the alveolar level of the drug without increasing systemic toxicity. This study aimed to evaluate the efficacy and safety of AA as an adjunctive therapy for VAP caused by MDR-GNB. METHODS: In this single-center, double-blind study conducted in a 36-bed general Intensive Care Unit (ICU) in a tertiary hospital from June 2014 to June 2016, 52 ICU patients with confirmed MDR-GNB VAP were randomized to two groups (AA group, n = 27 and placebo group, n = 25)...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28450200/aerosolized-tobramycin-for-pseudomonas-aeruginosa-ventilator-associated-pneumonia-in-patients-with-acute-respiratory-distress-syndrome
#16
Yohei Migiyama, Susumu Hirosako, Kentaro Tokunaga, Emi Migiyama, Takahiro Tashiro, Katsuyuki Sagishima, Hidenobu Kamohara, Yoshihiro Kinoshita, Hirotsugu Kohrogi
BACKGROUND: Ventilator-associated pneumonia (VAP) due to Pseudomonas aeruginosa has a high mortality and recurrence rate, especially in patients with acute respiratory distress syndrome (ARDS). Therefore, new therapeutic strategies against severe pneumonia are needed. This study evaluated the efficacy of aerosolized tobramycin for P. aeruginosa VAP in ARDS patients. METHODS: A retrospective analysis was performed on patients who developed VAP caused by P. aeruginosa during the course of ARDS at the intensive care unit (ICU) of Kumamoto University Hospital...
August 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28400338/recommendations-for-aerosolized-antibiotics-in-ventilator-associated-pneumonia-and-ventilator-associated-tracheobronchitis-too-little-and-too-late
#17
M H Kollef, S T Micek
No abstract text is available yet for this article.
September 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28394614/synthetic-macromolecular-antibiotic-platform-for-inhalable-therapy-against-aerosolized-intracellular-alveolar-infections
#18
Debobrato Das, Jasmin Chen, Selvi Srinivasan, Abby M Kelly, Brian Lee, Hye-Nam Son, Frank Radella, T Eoin West, Daniel M Ratner, Anthony J Convertine, Shawn J Skerrett, Patrick S Stayton
Lung-based intracellular bacterial infections remain one of the most challenging infectious disease settings. For example, the current standard for treating Franciscella tularensis pneumonia (tularemia) relies on administration of oral or intravenous antibiotics that poorly achieve and sustain pulmonary drug bioavailability. Inhalable antibiotic formulations are approved and in clinical development for upper respiratory infections, but sustained drug dosing from inhaled antibiotics against alveolar intracellular infections remains a current unmet need...
May 9, 2017: Molecular Pharmaceutics
https://www.readbyqxmd.com/read/28352199/survey-on-attitudes-of-italian-pediatricians-toward-cough
#19
Alessandro Zanasi, Luigi Morcaldi, Salvatore Cazzato, Massimiliano Mazzolini, Marzia Lecchi, Antonio Maria Morselli-Labate, Marianna Mastroroberto, Roberto W Dal Negro
CONTEXT: Children's cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions - sometimes substantially. OBJECTIVE: The objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28347790/key-considerations-on-nebulization-of-antimicrobial-agents-to-mechanically-ventilated-patients
#20
J Rello, J J Rouby, C Sole-Lleonart, J Chastre, S Blot, C E Luyt, J Riera, M C Vos, A Monsel, J Dhanani, J A Roberts
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers...
March 25, 2017: Clinical Microbiology and Infection
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