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. 2019 Mar 16;8(1):27.
doi: 10.3390/antibiotics8010027.

A Breath of Fresh Air in the Fog of Antimicrobial Resistance: Inhaled Polymyxins for Gram-Negative Pneumonia

Free PMC article

A Breath of Fresh Air in the Fog of Antimicrobial Resistance: Inhaled Polymyxins for Gram-Negative Pneumonia

Mark Biagi et al. Antibiotics (Basel). .
Free PMC article


Despite advancements in therapy, pneumonia remains the leading cause of death due to infectious diseases. Novel treatment strategies are desperately needed to optimize the antimicrobial therapy of patients suffering from this disease. One such strategy that has recently garnered significant attention is the use of inhaled antibiotics to rapidly achieve therapeutic concentrations directly at the site of infection. In particular, there is significant interest in the role of inhaled polymyxins for the treatment of nosocomial pneumonia, including ventilator-associated pneumonia, due to their retained activity against multi-drug resistant Gram-negative pathogens, including Acinetobacter baumannii and Pseudomonas aeruginosa. This review will provide a comprehensive overview of the pharmacokinetic/pharmacodynamic profile, clinical outcomes, safety, and potential role of inhaled polymyxins in clinical practice.

Keywords: HAP; VAP; colistin; inhaled antibiotics; pneumonia; polymyxin.

Conflict of interest statement

E.W. serves on the speaker’s bureau for Melinta Therapeutics, Astellas Pharma, and Achaogen and on the advisory board for Shionogi. All other authors certify no potential conflicts of interest.


Figure 1
Figure 1
CMS (top panels) and colistin (bottom panels) concentrations in ELF (open squares) and plasma (filled triangles) following a single dose via aerosol or IV administration at steady state. Reprinted with permission from Boisson et al [35].

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