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Gipsman A, Prero M, Toltzis P, Craven D. Inhaled antibiotics in children with tracheostomy tubes: A descriptive study. Pediatr Pulmonol 2023; 58:1028-1033. [PMID: 36541025 DOI: 10.1002/ppul.26288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/07/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Respiratory tract infections (RTIs) are common in children with tracheostomy tubes. Anecdotally, inhaled antibiotics are commonly prescribed, although to date there are no studies describing their use in this patient population. The objective of this study was to assess the variability of this practice at a single tertiary care children's hospital. METHODS All children admitted to our hospital with a tracheostomy tube who were prescribed inhaled antibiotics between 2013 and 2020 were included. Patient characteristics and data regarding inhaled antibiotic use were obtained retrospectively from the electronic medical record. RESULTS A total of 424 courses of inhaled antibiotics were prescribed during the study period. 296 (69.8%) courses were prescribed to treat an acute RTI, whereas 128 (30.2%) were prescribed prophylactically to prevent RTIs. 58.9% of children with tracheostomy tubes hospitalized during the study period received at least one course of inhaled antibiotics. The most common antibiotics prescribed were tobramycin and gentamicin; several different doses were used. In 53.2% of treatment courses, inhaled antibiotics were co-prescribed with systemic antibiotics. Therapy duration for treatment varied from 3 to 28 days. Respiratory cultures were used variably and antimicrobial susceptibility was often not taken into account when prescribing inhaled antibiotics. CONCLUSIONS Inhaled antibiotics were frequently prescribed as treatment and prophylaxis in children with tracheostomy tubes at our center, with significant variation in the prescribed antibiotic type, dose, frequency, duration, and co-prescription with systemic antibiotics. Prospective studies are needed to define best practice regarding inhaled antibiotics in this patient population.
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Affiliation(s)
- Alexander Gipsman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Moshe Prero
- Department of Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Philip Toltzis
- Department of Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Daniel Craven
- Department of Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Inhaled antibiotics in critical care: state of the art and future perspectives. Infect Dis Now 2022; 52:327-333. [DOI: 10.1016/j.idnow.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022]
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Gipsman A, Prero M, Toltzis P, Craven D. Tracheobronchitis in children with tracheostomy tubes: Overview of a challenging problem. Pediatr Pulmonol 2022; 57:814-821. [PMID: 34981895 DOI: 10.1002/ppul.25814] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/16/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022]
Abstract
Tracheobronchitis is common in children with tracheostomy tubes. These children are predisposed to respiratory infections due to the bypassing of normal upper airway defense mechanisms by the tracheostomy, bacterial colonization of the tracheostomy tube itself, and underlying medical conditions. Diagnosis of bacterial tracheobronchitis is challenging due to the difficulty in differentiating between bacterial colonization and infection, as well as between viral and bacterial etiologies. Difficulty in diagnosis complicates management decisions, and there are currently no consensus guidelines to assist clinicians in the treatment of these patients. Frequent administration of systemic antibiotics causes adverse effects and leads to the emergence of resistant organisms. Topical administration of antibiotics via nebulization or direct instillation may lead to a significantly higher concentration of drug in the upper and lower airways without causing systemic side effects, although therapeutic trials in children with tracheostomy tubes are lacking. Several preventative measures such as regular airway clearance and the use of a speaking valve may mitigate the risk of developing respiratory infections.
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Affiliation(s)
- Alexander Gipsman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Moshe Prero
- Department of Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Philip Toltzis
- Department of Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Daniel Craven
- Department of Pulmonology, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Maxwell A, Mary E, Ghate V, Aranjani J, Lewis S. A Novel high throughput 96-well based Fluorimetric Method to Measure Amikacin in Pharmaceutical Formulations: Development using Response Surface Methodology. LUMINESCENCE 2022; 37:930-943. [PMID: 35322527 DOI: 10.1002/bio.4238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/24/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
An aminoglycoside antibiotic, amikacin, is used to treat severe and recurring bacterial infections. Due to the absence of a chromophore, however, amikacin must be extensively derivatized before being quantified, both in analytical and bioanalytical samples. In this study, for the first time, we developed a simple and sensitive method for measuring amikacin sulfate by spectrofluorimetry using a 96-well plate reader, based on the design of the experiment's approach. To develop a robust and reproducible spectrofluorimetric method, the influence of essential attributes, namely pH of the buffer, heating temperature, and concentration of reagents, were evaluated by univariate analysis followed by multivariate analysis (central composite design). ICH guidelines were used to validate the optimized method. The developed technique is linear from 1.9 to 10 μg/mL with a regression coefficient of 0.9991. The detection and quantification limits were 0.649 μg/mL and 1.9 μg/mL, respectively. For the developed method, both intra- and inter-day precision (%RSD) were below 5%. Using the method, amikacin concentrations were quantified in prepared amikacin liposomes and commercial formulations of Amicin®. The developed method greatly reduces sample volume and is a rapid, high throughput microplate-based fluorescence approach for the convenient and cost-effective measurement of amikacin in pharmaceutical formulations. In comparison to previously published approaches, the suggested method allowed for quick analysis of a high number of samples in a short amount of time (96 samples in 125 seconds), resulting in an average duration of analysis of 1.3 seconds per sample.
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Affiliation(s)
- Amala Maxwell
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Elizabeth Mary
- Department of School of Pharmacy, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Vivek Ghate
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Jesil Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Shaila Lewis
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
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Desgrouas M, Ehrmann S. Inhaled antibiotics during mechanical ventilation-why it will work. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:598. [PMID: 33987296 DOI: 10.21037/atm-20-3686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Inhaled antibiotics are a common therapy among patients suffering recurrent or chronic pulmonary infections. Their use is less frequent in acutely ill patients despite a strong theoretical rationale and growing evidence of their efficiency, safety and beneficial effect on reducing bacterial resistance emergence. Clinical trials of inhaled antibiotics have shown contradictory results among mechanically ventilated patients. The optimal nebulization setup, not always implemented in all trials, the difficulty to identify the population most likely to benefit and the testing of various therapeutic strategies such as adjunctive versus alternative to systemic antibiotics may explain the disparity in trial results. The present review first presents the reasons why inhaled antibiotics have to be developed and the benefits to be expected of inhaled anti-infectious therapy among mechanically ventilated patients. A second part develops the constraints of aerosolized therapies that one has to be aware of and the simple actions required during nebulization to ensure optimal delivery to the distal lung parenchyma. Positive and negative studies concerning inhaled antibiotics are compared to understand the discrepancies of their findings and conclusions. The last part presents current developments and perspective which will likely turn it into a fully successful therapeutic modality, and makes the link between inhaled antibiotics and inhaled anti-infectious therapy.
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Affiliation(s)
- Maxime Desgrouas
- CHRU Tours, Médecine Intensive Réanimation, Tours, France.,CHR Orléans, Médecine Intensive Réanimation, Orléans, France.,INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France
| | - Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, Tours, France.,INSERM, Centre d'étude des pathologies respiratoires, U1100, Université de Tours, Tours, France
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Ehrmann S, Schmid O, Darquenne C, Rothen-Rutishauser B, Sznitman J, Yang L, Barosova H, Vecellio L, Mitchell J, Heuze-Vourc’h N. Innovative preclinical models for pulmonary drug delivery research. Expert Opin Drug Deliv 2020; 17:463-478. [PMID: 32057260 PMCID: PMC8083945 DOI: 10.1080/17425247.2020.1730807] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/11/2020] [Indexed: 02/08/2023]
Abstract
Introduction: Pulmonary drug delivery is a complex field of research combining physics which drive aerosol transport and deposition and biology which underpins efficacy and toxicity of inhaled drugs. A myriad of preclinical methods, ranging from in-silico to in-vitro, ex-vivo and in-vivo, can be implemented.Areas covered: The present review covers in-silico mathematical and computational fluid dynamics modelization of aerosol deposition, cascade impactor technology to estimated drug delivery and deposition, advanced in-vitro cell culture methods and associated aerosol exposure, lung-on-chip technology, ex-vivo modeling, in-vivo inhaled drug delivery, lung imaging, and longitudinal pharmacokinetic analysis.Expert opinion: No single preclinical model can be advocated; all methods are fundamentally complementary and should be implemented based on benefits and drawbacks to answer specific scientific questions. The overall best scientific strategy depends, among others, on the product under investigations, inhalation device design, disease of interest, clinical patient population, previous knowledge. Preclinical testing is not to be separated from clinical evaluation, as small proof-of-concept clinical studies or conversely large-scale clinical big data may inform preclinical testing. The extend of expertise required for such translational research is unlikely to be found in one single laboratory calling for the setup of multinational large-scale research consortiums.
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Affiliation(s)
- Stephan Ehrmann
- CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSep network, Tours France
- INSERM, Centre d’étude des pathologies respiratoires, U1100, Tours, France
- Université de Tours, Tours, France
| | - Otmar Schmid
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany
- Institute of Lung Biology and Disease, Helmholtz Zentrum München – German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Chantal Darquenne
- Department of Medicine, University of California, San Diego, 9500 Gilman Drive, MC0623A, La Jolla, CA 92093-0623, United States
| | | | - Josue Sznitman
- Department of Biomedical Engineering, Technion - Israel Institute of Technology, Julius Silver building, Office 246, Haifa 32000, Israel
| | - Lin Yang
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Max-Lebsche-Platz 31, 81377 Munich, Germany
- Institute of Lung Biology and Disease, Helmholtz Zentrum München – German Research Center for Environmental Health, Ingolstaedter Landstrasse 1, 85764 Neuherberg, Germany
| | - Hana Barosova
- Adolphe Merkle Institute, University of Fribourg, Chemin des Verdiers 4, Fribourg, Switzerland
| | - Laurent Vecellio
- INSERM, Centre d’étude des pathologies respiratoires, U1100, Tours, France
- Université de Tours, Tours, France
| | - Jolyon Mitchell
- Jolyon Mitchell Inhaler Consulting Services Inc., 1154 St. Anthony Road, London, Ontario, Canada, N6H 2R1
| | - Nathalie Heuze-Vourc’h
- INSERM, Centre d’étude des pathologies respiratoires, U1100, Tours, France
- Université de Tours, Tours, France
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