Antibióticos inhalados y bronquiectasia por fibrosis no quística: tratando de resolver el rompecabezas
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1Department of Pulmonary Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India.
Lung India : official organ of Indian Chest Society
|September 2, 2025
Resumen
Los antibióticos inhalados pueden reducir las exacerbaciones en la bronquiectasia por fibrosis no quística (NCFB) en pacientes específicos. Sin embargo, pueden aumentar la resistencia antimicrobiana y no mejoran la función pulmonar, lo que requiere una cuidadosa consideración.
Área de la Ciencia:
- Medicina de los pulmones
- Enfermedades infecciosas
- Farmacología
Sus antecedentes:
- La bronquiectasia es una enfermedad crónica de las vías respiratorias caracterizada por exacerbaciones recurrentes y hospitalizaciones.
- Los tratamientos antibióticos inhalados actuales para la bronquiectasia por fibrosis no quística (NCFB) carecen de beneficios consistentemente probados.
Objetivo del estudio:
- Revisar las pruebas sobre los antibióticos inhalados en el NCFB.
- Identificar las características del paciente que pueden predecir el beneficio de los antibióticos inhalados.
- Para resaltar las brechas de investigación en esta área terapéutica.
Principales métodos:
- Se realizó una búsqueda sistemática de la literatura en PubMed utilizando los términos "antibióticos inhalados Y bronquiectasia".
- Se analizaron cinco antibióticos inhalados (aztreonam, tobramicina, gentamicina, ciprofloxacina, colistina) estudiados en ensayos controlados aleatorios (ECA).
- Se identificaron características de los pacientes asociadas con el beneficio del tratamiento.
Principales resultados:
- Los antibióticos inhalados redujeron la frecuencia de la exacerbación y la densidad bacteriana del esputo, y aumentaron la erradicación bacteriana, pero no mejoraron la función pulmonar.
- La resistencia a los antimicrobianos aumentó, con mayores tasas de interrupción del tratamiento con aztreonam y aminoglucósidos debido a los efectos secundarios.
- Los pacientes con alta densidad bacteriana de esputo, exacerbaciones frecuentes y aumento del volumen/purulencia de esputo al inicio mostraron un beneficio potencial.
Conclusiones:
- Los antibióticos inhalados pueden ser beneficiosos para algunos pacientes con NCFB, particularmente para la erradicación de Pseudomonas aeruginosa después del aislamiento inicial.
- El papel de los antibióticos inhalados durante las exacerbaciones agudas requiere más investigación.
- Se necesita más investigación para comparar diferentes sistemas de administración, antibióticos y regímenes.
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