Table 2– Considerations when prescribing inhaled antibiotics
The concentration gradient of an inhaled antibiotic goes progressively down from central airways towards the small airways
There is a preferential flow of inhaled antibiotic towards the more healthy regions of the lung
The more diseased the lung, the more inhomogeneous the deposition pattern and the more regions will be suboptimally treated
Subinhibitory concentrations of inhaled antibiotics are likely to occur in advanced disease
Inhalation of an antibiotic by DPI is faster and cleaner relative to nebulised antibiotics
The aerosol characteristics of an inhaled antibiotic by DPI depend on formulation, device and inhalation manoeuvre
Each antibiotic inhaled by DPI has a device- and formulation-specific optimal inhalation profile
The patient (and parents in the case of children) should both be aware of the optimal inhalation profile
The efficacy of inhaled antibiotic therapy is determined by adherence and inhalation competence
Inhalation technique should be repeatedly evaluated and patients (parents) repeatedly trained
In case of a suboptimal therapeutic treatment result, check and recheck inhalation competence
For patients using a DPI but who cannot reproducibly generate the optimal inhalation profile, consider switching back to a nebuliser or to a smart nebuliser that guides the patient in optimising the inhalation manoeuvre
  • DPI: dry powder inhaler.