[The future of inhaled antibiotic therapy. New products]

Inhaled antibiotics have been used for more than 30 years to treat bronchial colonization or infection, especially in patients with cystic fibrosis and chronic bronchial infection with Pseudomonas. However, major progress in this field has only been made in the last 10 years: the beneficial effects in this indication have been confirmed by scientific evidence, the number of clinical trials has considerably increased, inhaled antibiotic formulations have appeared, administration systems have improved and their use has been broadened to include other infections. The speed of research indicates that major advances will be made in the indications and arsenal of inhaled antibiotics, as well as in the effectiveness of administration systems in the next 10 years. A desirable aim in the immediate future would be to demonstrate the efficacy of inhaled antibiotics in the treatment of any chronic bronchial infection, irrespective of the causative microorganism or the underlying disease and even in the absence of bronchiectasis. The antibiotic effect is related to the concentration achieved in the site of infection. Antibiotic administration through the inhaled route is subject to many variables: the dose administered, the dose that reaches the site of infection, the type of nebulizer used and the patient's characteristics. Many features of the pharmacokinetics of this route remain unknown and, because of its complexity, it should be prescribed and monitored by specialist physicians to avoid underdosing, which could lead to bacterial resistance.