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Only for medical professionals to read for reference.
What are the antibacterial and fungal drugs for topical use through the airway? What should I pay attention to when using? Anti-infective drugs used locally through the airway, such as antibacterial drugs and antifungal drugs, have the characteristics of high local drug concentration and low systemic absorption.
The routes of administration include atomization inhalation, dry powder inhalation and bronchoscopy injection, which can be used for systemic medication.
Patients with refractory pulmonary infections with unsatisfactory efficacy, such as aminoglycoside drugs and polymyxin drugs in the treatment of multidrug-resistant (MDR) pathogens, especially caused by extensive drug-resistant (XDR) gram-negative bacilli (GNB) Ventilator-associated pneumonia (VAP), tobramycin aerosol inhalation to treat cystic fibrosis (CF) disease Pseudomonas aeruginosa (PA) infection and aztreonam inhalation to improve the infection of Pseudomonas aeruginosa Respiratory symptoms of cystic fibrosis (CF) caused by bacteria (PA).
So, what are the antibacterial and fungal drugs for topical use through the airway? What should I pay attention to when using? 1.
Anti-infective drugs for topical use via the airway, such as antibacterial drugs and antifungal drugs.
1 Antibacterial drugs such as β-lactam drugs, aminoglycoside drugs, quinolone drugs.
① β-lactam drugs aztreonam and ceftazidime are the most commonly used drugs in the lower respiratory tract.
②Aminoglycoside drugs Aminoglycoside drugs are used for local antibacterial treatment of lower respiratory tract.
They are characterized by poor penetration of lung tissue after intravenous administration, high concentration of alveolar epithelial lining fluid (ELF) after inhalation and low systemic exposure.
Such as tobramycin and amikacin.
③The quinolone drugs ciprofloxacin and levofloxacin have research data on the topical application of lower respiratory tract.
2 Antifungal drug Amphotericin B is a polyene drug, and a variety of intravenous dosage forms have been marketed, including deoxycholate and lipid-containing preparations (such as amphotericin B liposome, amphotericin B colloidal dispersion, amphotericin B Amphotericin B phospholipid complex and amphotericin B lipid complex), in which the instructions for deoxycholate amphotericin B for injection include aerosol administration.
Topical application of amphotericin B can treat chronic pulmonary aspergillosis (CPA) or prevent lung transplantation, delayed recovery of agranulocytosis and other immunosuppressed patients with invasive pulmonary aspergillosis (IPA).
In addition, bronchoscope intracavitary injection is also used for the treatment of pulmonary mycosis, such as amphotericin B alone or in combination for the treatment of CPA.
There are also reports of the use of voriconazole in China.
For severe invasive fungal infections, including pulmonary mucor that does not respond to systemic treatment, there are also reports of bronchoscopy infusion of antifungal drugs, and amphotericin B is often used.
two.
The adverse effects of local anti-infective treatment through the airway ultrasonic atomization and the large amount of mist particles are not recommended for patients with obstructive pulmonary diseases such as bronchial asthma.
DPI can affect the entry of drugs into the lower respiratory tract due to insufficient inhalation ability in the elderly and weak.
For refractory bacterial infections, local injection may cause transient acute damage to the tracheal mucosa and lung tissues, and routine use is not recommended.
Reference materials: [1] Expert consensus on the local application of adult anti-infective drugs in the lower respiratory tract[J].
Chinese Journal of Tuberculosis and Respiratory, 2021,44(4):322-333[2] Experts on the application of nebulized inhalation therapy in respiratory diseases Consensus[J].
Chinese Medical Journal,2016,96(34):2696-2706[3]Expert consensus on the usage of antibacterial drugs over the instructions[J].
Chinese Journal of Tuberculosis and Respiratory Medicine,2015,38(6):415[4] Expert consensus on the emergency clinical application of nebulized inhalation therapy (2018)[J].
Chinese Emergency Medicine,2018,38(7):565-573