Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives.
BACKGROUND
Non-cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive, suppurative lung disease characterized by permanent dilatation of bronchial subdivisions, which further causes accumulation of sputum and bacterial infections. The advent of inhaled antibiotics over the past two decades has been expected to effectively attenuate the problem of chronic bacterial infections in CF and NCFB subjects with higher, local drug concentrations and minimal systemic side effects.


METHODS
This review summarizes and evaluates current clinical evidence of efficacy and adverse effects of inhaled antibiotics in NCFB, as well as ongoing preclinical and clinical studies, followed by a discussion of issues and challenges in clinical practice and drug delivery strategies, together with future research directions.


CONCLUSIONS
The evidence base of the clinical efficacy of inhaled antibiotics in NCFB is limited and the degrees of reported clinical benefits have been modest and conflicting. Challenges surrounding inhaled antibiotics application and development include the lack of knowledge of disease factors and optimum management strategies, unreceptive lung pathophysiology and the lack of factors that support compliance and tolerability. Nonetheless, research continues to give birth to new clinical findings and novel formulations such as combination antibiotics and sustained-release formulations, which add great value to the development of efficacious, safe and convenient inhalable antibiotics of the future.
a 1 The University of Sydney , NSW 2006, Sydney, Australia.
Tiffanie Daisy
TD
Sugianto
b 2 The University of Sydney, Advanced Drug Delivery Group , NSW 2006, Sydney, Australia +61 2 9351 3054 ; kim.chan@sydney.edu.au.
Hak-Kim
HK
Chan
D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy*; D001987:Bronchiectasis / Q000150:complications*; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D016503:Drug Delivery Systems; D006801:Humans
D000900:Anti-Bacterial Agents
Pseudomonas aeruginosa; combination antibiotics; inhaled antibiotics; non-cystic fibrosis bronchhiectasis; respiratory tract infections; sustained-release antibiotics