Inhalative Antibiotika – eine Option für die Zukunft?

Kernaussagen

• Inhalative Antibiotika haben bei der Behandlung der zystischen Fibrose einen eindeutigen Stellenwert. Für andere Erkrankungen (Bronchiektasen, beatmungsassoziierte Pneumonien) gibt es vielversprechende Daten. Weitere große Studien stehen noch aus.

• Inhalatives Tobramycin ist das bislang am besten untersuchte inhalative Antibiotikum. Es hat eine gute Wirksamkeit gegen gramnegative Keime und nur wenige Nebenwirkungen.

• Inhalatives Colistin findet bereits breite Anwendung bei der zystischen Fibrose. In Hochresistenzländern könnte es zur zusätzlichen Behandlung beatmungsassoziierter Pneumonien durch multiresistente Keime künftig an Bedeutung gewinnen.

• Das kürzlich zugelassene inhalative Antibiotikum Aztreonam könnte den Handlungsspielraum bei chronischer Besiedlung erweitern.

• Inhalative Antibiotika können in der Lunge eine hohe Konzentration erreichen und haben im Vergleich zur systemischen Therapie geringere Nebenwirkungen. Weitere randomisierte kontrollierte Studien sind jedoch erforderlich, um den Nutzen zu belegen.

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