Inhalatorni antibiotici i indikacije za njihovu primjenu

master's thesis

• Title (english): Inhaled antibiotics and indications for their use
• Author: Patrik Bolković
• Mentor: Andrea Vukić Dugac (mentor)
• Committee member: Gordana Pavliša (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Andrea Vukić Dugac (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Inhalatorni su se antibiotici počeli primjenjivati 40-ih godina 20. stoljeća za liječenje kroničnih infekcija dišnog sustava, najprije kao aerosolizirani oblici antibiotika namijenjenih parenteralnoj primjeni. Takvi su pripravci pokazivali određene nedostatke, kao što je značajna iritacija dišnih puteva pa se započelo s njihovom prilagodbom i razvojem formulacija sigurnih za primjenu putem inhalacija. Glavne prednosti inhalatornih antibiotika u odnosu na intravensku i oralnu primjenu su dostava aktivne tvari izravno u pluća, smanjena sistemska apsorpcija i manji broj sistemskih nuspojava. Prvi antibiotik odobren za ovakav način administracije bio je tobramicin i to za kontrolu kronične kolonizacije bakterijom P. aeruginosa u pacijenata s cističnom fibrozom. Osim tobramicina, danas se uspješno i sigurno primjenjuju i drugi inhalatorni antibiotici – aztreonam, kolistin, levofloksacin, amikacin, a putem inhalacija se off label koristi i parenteralni gentamicin. Dobre rezultate je pokazala i uporaba inhalatornog ceftazidima, fosfomicina, vankomicina i teikoplanina, no ti su antibiotici još u različitim fazama kliničkih ispitivanja. Najčešće indikacije u kojima se primjenjuju uključuju cističnu fibrozu, bronhiektazije, kroničnu opstruktivnu plućnu bolest, infekcije netuberkuloznim mikobakterijama i pneumoniju povezanu s mehaničkom ventilacijom. Ovakve formulacije antibiotika zahtijevaju posebne uređaje kojima se dostavljaju u pluća, to su nebulizatori i inhaleri suhog praha, a odabir uređaja ovisi o indiciranom antibiotiku i potrebama pacijenata.

Abstract (english)

Inhaled antibiotics have been used since the 1940s for the treatment of chronic respiratory system infections. Initially, they were used as aerosolized forms of antibiotics intended for parenteral administration. Such preparations had certain drawbacks, such as significant irritation of the respiratory tract, leading to the adaptation and development of formulations safe for inhalation. The main advantages of inhaled antibiotics compared to intravenous and oral administration are direct delivery of the active substance to the lungs, reduced systemic absorption, and fewer systemic side effects. The first antibiotic approved for this mode of administration was tobramycin, specifically for controlling chronic colonization of Pseudomonas aeruginosa in patients with cystic fibrosis. In addition to tobramycin, other inhalation antibiotics such as aztreonam, colistin, levofloxacin, and amikacin are successfully and safely used. Off-label use of parenteral gentamicin via inhalation is also practiced. The use of inhaled ceftazidime, fosfomycin, vancomycin, and teicoplanin has shown promising results, but these antibiotics are still in different stages of clinical trials. The most common indications for their use include cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, infections caused by non-tuberculous mycobacteria and pneumonia associated with mechanical ventilation. Such antibiotic formulations require special devices for delivery to the lungs, such as nebulizers and dry powder inhalers, and the choice of device depends on the indicated antibiotic and the patients' needs.

• Keywords: inhalatorni antibiotici; indikacije; kronične plućne infekcije; liječenje
• Keywords (english): inhaled antibiotics; indications; chronic pulmonary infections; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:381583
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-23 10:00:11