Inhalable Dry Powders of Antimicrobial Agents in Respiratory Diseases.

BACKGROUND: Respiratory infections remain a major global health burden despite advances in systemic antimicrobial therapy. Antimicrobial dry powder inhalers (DPIs) have emerged as precision-engineered pulmonary delivery platforms capable of achieving high local drug concentrations while minimizing systemic toxicity. OBJECTIVE: This review examines the historical evolution, pharmacological landscape, particle engineering technologies, translational challenges, and clinical progress of antibacterial, antiviral, and antifungal DPIs. CONTENT: We trace the evolution of antimicrobial DPIs from early aerosolized therapies to contemporary engineered systems, integratingdisease targets, pharmacological agents, particle and formulation engineering, inhaler technologies, patents, clinical development andregulatory milestones. Particular emphasis is placed on formulations supported by in vivo efficacy, clinical investigation or regulatoryapproval, highlighting advances in tuberculosis, chronic bacterial infections, viral respiratory diseases and pulmonary fungal infections. CONCLUSIONS: Antimicrobial DPIs are evolving toward precision pulmonary therapies, highlighting their expanding role in chronic infections, pandemic preparedness, and next-generation pulmonary anti-infective therapy. Overcoming dose, deposition, stability, andtranslational barriers will be critical for broader clinical adoption.