Recent and future developments in inhaled formulations to overcome anti-bacterial drug resistance

INTRODUCTION: Inhaled antibiotic delivery technology is considered an emerging method for overcoming continual challenges posed by resistant bacteria. It enables the delivery of highly localized drug concentrations, thereby reducing systemic exposure, whilst targeting infected cells to efficiently kill resistant bacteria. AREAS COVERED: The clinical outcomes of inhaled antibiotic delivery strategies against resistant bacteria are limited. With a focus on preclinical and clinical outcomes, this review highlights recent advances in the development of inhaled antibiotic formulations. Further, it emphasizes the emerging strategies as a blueprint for future therapeutic options against resistant bacteria. EXPERT OPINION: Inhaled antibiotic formulations represent one of the most promising avenues for overcoming antibacterial drug resistance. This is achieved by delivering high local doses of antibiotics directly to infected cells, which specifically targets biofilm/mucus and resistant pathogens. Although promising developments in inhaled antibacterials include proteins and peptides, liposomal and lipid‑based nano-carriers, combination therapies, phase therapy, and alveolar macrophage targeted delivery are progressing, some potential barriers such as mucus, biofilms, and bacterial resistance continue to impede clinical translation. As a result, real-world strategic priorities should be emphasized regarding the development of smart inhaled antibacterial formulations with clinical potential to overcome the ongoing barriers associated with antimicrobial-resistant bacteria.