Inhaled colistin for lower respiratory tract infections

Expert Opin Drug Deliv. 2012 Mar;9(3):333-42. doi: 10.1517/17425247.2012.660480. Epub 2012 Feb 14.


Introduction: Lower respiratory tract infections, due to Pseudomonas aeruginosa or Acinetobacter baumannii, are frequently encountered in patients with cystic fibrosis (CF) or in patients developing nosocomial pneumonias. Both of these conditions bear a high mortality risk and aggressive antibiotic therapy is necessary. Inhaled antibiotics might represent an effective therapeutic approach for these diseases as it has demonstrated good bactericidal efficacy and safety in both preclinical and clinical studies. This colistin formulation might be useful particularly in patients with respiratory tract infections due to multidrug-resistant Gram-negative bacteria. Its main advantages are a better safety profile with a minimal or absent risk of nephrotoxicity.

Areas covered: This paper discusses the available systemic formulations of colistin, with pharmacokinetic and safety profiles, followed by an overview of inhaled antibiotics in lower respiratory tract infections.

Expert opinion: Inhaled colistin should be used selectively as monotherapy in chronic infections with P. aeruginosa in CF patients, whereas in patients with hospital/ventilator-acquired pneumonia (HAP/VAP), it should be used in a combined regimen with systemic antibiotics.

Publication types

  • Review

MeSH terms

  • Acinetobacter Infections / drug therapy*
  • Acinetobacter baumannii / drug effects
  • Administration, Inhalation
  • Animals
  • Anti-Bacterial Agents / administration & dosage*
  • Bronchiectasis / drug therapy
  • Colistin / administration & dosage*
  • Cross Infection / drug therapy
  • Cystic Fibrosis / drug therapy
  • Drug Synergism
  • Drug Therapy, Combination
  • Humans
  • Pneumonia, Ventilator-Associated / drug therapy
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas aeruginosa / drug effects
  • Respiratory Tract Infections / drug therapy*


  • Anti-Bacterial Agents
  • Colistin