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    The International Society for Aerosols in Medicine

    Bruce Rubin

    Bruce Rubin

    Bruce Rubin

    Children’s Hospital of Richmond at VCU
    USA

     

    Bruce Rubin is the Jessie Ball duPont Distinguished Professor and Chair of Pediatrics at Virginia Commonwealth University, Physician in Chief of the Children’s Hospital of Richmond at VCU, and Professor of Biomedical Engineering, Physiology and Biophysics. As a Rhodes Scholar, he trained in Biomedical Engineering at Oxford University and then did a fellowship in Paediatric Respirology and Critical Care at Sick Kids in Toronto. He holds the MD and Masters in Engineering degrees from Tulane and an MBA degree from Wake Forest University Babcock School of Business. Prof. Rubin received Lifetime Scientific Achievement Awards from the AARC and CIPP, he holds honorary appointments in 4 medical schools, is on the editorial board of 11 pulmonary journals, has published more than 300 original research papers and chapters (H-index 58), and holds nine patents. His research focus is regulation of mucus clearance in health and disease, airway inflammation, cough, and aerosol delivery of medications

     

    Inhaled antibiotic delivery to children

    Abstract

    Aerosol antibiotics can deliver a high concentration to the site of infection with minimal systemic absorption. The ideal patients for receiving aerosol antibiotics are those with chronic airway infection and the ideal antibiotics for aerosolization are the concentration dependent (AUC/MIC90) antimicrobials which increase their killing potential the greater the AUC.

    There are limitations to the delivery of aerosol antibiotics. Secretions can limit the diffusion of aerosol antibiotics to the distal airway promoting antibiotic resistance. As a chronically administered therapy given for months or years, poor adherence also increases the likely development of resistance. Antimicrobial resistance to inhaled antibiotics reverses on removal of the antibiotic as maintenance of resistance factors by bacteria carries a metabolic cost.

    Difficulties in developing aerosol antibiotics include trial design as decreased sputum bacterial density does not directly translate to clinical benefits. Outcomes such as infectious exacerbations and hospital admissions tend to be rare events, and changes in pulmonary function are not a sensitive outcome. Special issues related to the delivery to young children include when to initiate therapy and dosage needed based on the patient’s age, delivery device being used, the effectiveness of use at different ages, and the relative degree of airway obstruction.

    Goals for developing aerosol antibiotics include effective delivery to the sinuses to reduce the risk of reseeding, the adjunctive delivery of medications that may allow deeper penetration of the antibiotic into purulent secretions, and administration of a biofilm disruptor which may improve effectiveness of the antibiotics.