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Improving Inhaled Antibiotic Treatment Against Respiratory Biofilm Infections

Ong H.

RDD Europe 2019. Volume 1, 2019: 27-36.

Abstract:

The failure of chronic therapy with antibiotics by any route of administration to clear persistent respiratory infection is the key morbidity and mortality factor for patients with chronic lung diseases. This is due to the presence of biofilms of non-motile bacteria in a dormant state that have a high tolerance to antibiotics. The current strategy for antibiotic use is focused on suppressing pathogens rather than eradicating them. This approach enhances the likelihood of developing persistent respiratory infection. Biofilms provide a reservoir for continual exposure of the lungs to the bacteria that drive inflammation and disease progression, which are important features in establishing chronic lung infection. While biofilms play a role in infection persistence, planktonic forms of bacteria have been found to play a role in acute pulmonary exacerbations (APEs). Generally, there are two limitations to treating biofilms in the lungs: 1) the current inhaled antibiotic mode of use focuses on planktonic forms and ignores the contribution of the biofilm component, and 2) there is a lack of relevant in vitro biofilm models that could be used as a pre-clinical testing platform to accelerate translation of treatments to the clinic. To overcome these limitations, novel strategies that target key elements in the lifecycle of biofilms should be developed in order to treat persistent respiratory infection and reduce APEs.