Inhaled drug treatment for tuberculosis: Past progress and future prospects

• Published in: Journal of controlled release Vol. 240; pp. 127 - 134
• Main Authors: Hickey, A.J., Durham, P.G., Dharmadhikari, A., Nardell, E.A.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 28.10.2016
• Subjects: Administration, Inhalation; Aerosols; Animals; Antibiotics; Antitubercular Agents - administration & dosage; Antitubercular Agents - metabolism; case studies; drug therapy; Forecasting; funding; HIV Infections - drug therapy; HIV Infections - metabolism; Human immunodeficiency virus; Humans; Inhaled therapy; lungs; mixed infection; multiple drug resistance; Mycobacterium tuberculosis; Nebulizers and Vaporizers - trends; new drugs; patients; Pulmonary drug delivery; risk; toxicity; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - metabolism; Aerosols; Pulmonary drug delivery; Tuberculosis; Inhaled therapy; Mycobacterium tuberculosis; Antibiotics
• ISSN: 0168-3659; 1873-4995
• DOI: 10.1016/j.jconrel.2015.11.018

Since the 1990s the rising incidence of multiple drug resistant TB, particularly in the context of human immunodeficiency virus co-infected patients, has threatened global TB control. At that time funding agencies began to support formal investigation of aerosol therapy which until then had been the subject of case reports of individual investigators. Over the last decade, proponents of aerosol therapy have increased in number within the TB research community as the incidence of multiple and extremely drug resistant TB has increased dramatically around the world. Aerosol therapy offers the potential to deliver drug at target concentrations directly into the lungs, use the alveolar-capillary interface to achieve systemic levels, while reducing the risk of systemic toxicity seen with parentally administered doses. In addition, there are insufficient new drugs in the pipeline to anticipate the appearance of a new regimen in time to assure future control of drug resistance. Consequently, alternative strategies are critical to achieving global TB control, and inhaled therapies should be considered as one such strategy. [Display omitted]