Giving antibiotics through an inhaler can help fight bacterial resistance

One of the principles of medical practice is that a drug is given in the lowest effective dose possible for the shortest possible time. A huge step forward in the treatment of lung infections ­applies this principle and prevents bacterial resistance to antibiotics at the same time. How?

Researchers from the universities of Bristol and Bath are proposing to use inhaled antibiotics, as opposed to oral.

Acute lower respiratory tract ­infections are the most common condition seen in general practice worldwide and antibiotic resistant strains are the leading cause of antimicrobial deaths.

Despite this, antibiotics given by mouth in the form of tablets, capsules or liquid are inappropriate in half of all cases, contributing to antimicrobial resistance and waste of medicines.

An inhaled antibiotic, however, focuses on the infected part of the body and isn’t diluted by being distributed around the body, so the lowest possible dose can be used.

Professor Alastair Hay from the Centre for Academic Primary Care at the University of Bristol is lead author of a recent report proposing inhaled antibiotics could be effective in treating people seen in general practice, particularly those with long term lung conditions such as asthma and chronic obstructive pulmonary disease (COPD).

He says: “These patients are already familiar with using inhalers, and inhaled antibiotics could deliver higher concentrations in smaller doses than when taken by mouth, and therefore cause less harm.

“A lot of damage can be done through the inappropriate use of oral antibiotics, including side effects such as diarrhoea, vomiting and skin rashes, and damage to healthy gut bacteria that are indiscriminately destroyed, allowing resistant bacteria to flourish.

“Inhaled antibiotics could reduce side effects and these so-called ‘bystander’ antimicrobial resistance effects, by ensuring only the affected part of the body is treated.

“The evidence base for using inhaled antibiotics is really lacking, but the evidence that is available suggests they could be a game-changer when it comes to the treatment of acute lower respiratory tract infections.”

Prof Hay argues it is vital to consider all avenues to combat antimicrobial resistance due to the huge public health threat it poses globally.

He adds: “We are calling on governments to make funds available for companies to develop drug delivery systems so patients can reduce use of oral antibiotics and thereby reduce the risks of developing side effects and acquiring antibiotic resistant bacteria.”

Great idea.