I'm working on dysphagia screening during acute phase of stroke, and I would like to optimize pneumonia prevention.
First of all, I am impressed by the survey given on history and diversity of inhalative antibiotics given above. Thanks a lot!
Now, your question was, whether it could be reasonable to introduce some of the mentioned drugs as preventive antibiotic inhalation in a special cohort of patients who are at high risk for recurrent aspiration, due to a recent stroke which can cause dysphagia.
Altogether, one of the principal reasons to develop inhalative antibiotics, as given above, is chronic colonization of CF patients´ lungs with gram negative pathogens like Pseudomonas aeruginosa. These pathogens colonize about 70-80% of CF patients´ lungs and by the resulting inflammation and direct virulence of the bacteria, Pseudomonas aeruginosa remains a principal reason for premature death with CF. Thereby, besides Ciprofloxacin, most effective antibiotics against the bacterium need to be applied intravenously or by inhalation, as they are not sufficiently absorbed in the intestine.
Principal pathogens acquired by aspiration include gram positive and negative bacteria growing aerobic and anaerobically (polymicrobial etiology). Thereby, antibiotic recommendations for aspiration pneumonia are not optimally followed by the antibiotics, which presently are available for inhalative therapy. Moreover, systemically applied antibiotics would easier to handle.
In this regards, independently, whether you apply inhalative antibiotics by a dry powder or by a nebulizer, this treatment requires coordination, e.g. closing of the mouth around mouthpieces and by certain inhalative maneuvers. All of these would be difficult to manage by your cohort of patients.
Altogether, I do not think that at present in your patients with dysphagia after a stroke antibiotic inhalation would optimize pneumonia prevention.
Kind Regards,
Jochen
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