The role of nebulized antibiotics in treating serious respiratory infections.

The administration of a nebulized antibiotic in serious respiratory tract infections ensures high antibiotic concentrations at the site of infection, minimising systemic concentrations and their resultant risk of toxicity. Nebulized antibiotics have been used for the treatment of chronic infection with Pseudomonas aeruginosa, particularly in cystic fibrosis, but with variable clinical efficacy. Antibiotic delivery by nebulization is greatly influenced by the product formulation and the nebulizer. Use of intravenous formulations via a nebulizer can lead to exposure to potentially irritant or toxic additives and inappropriate pH or osmolality ranges, whilst the choice of nebulizer can greatly influence the drug deposition in the airway. Tobramycin Nebulizer Solution (TNS) is the first specific formulation for nebulization in cystic fibrosis using a designated nebulizer. The potential extrapolation of nebulized antibiotic therapy to other serious respiratory infections, in particular bronchiectasis and ventilator-associated pneumonia, is explored in this review.