Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has strong invasiveness, not only causing local lung inflammation, but also capable of penetrating alveolar epithelial cells and entering the bloodstream, thereby triggering systemic infection. This study aims at develop an alternative and effective drug delivery system through the inhalation therapy to address the limitations of polymyxin B (PMB) intravenous treatment for multidrug-resistant CRPA pneumonia, such as low lung concentration and nephrotoxicity, while also achieving systemic therapeutic effects. We prepared PMB dry powder inhalers (DPIs) using air jet milling and spray drying techniques. The prepared DPIs were characterized in terms of micromorphology, geometric particle size distribution, density, flowability, and surface roughness. Furthermore, we assessed the in vitro lung deposition and antibacterial efficacy of these inhalers.To compare the systemic exposure following changes in administration routes, blood concentration measurements were conducted for different routes of administration Spherical PMB particles, measuring 3 microns in diameter, achieved the highest fine particle fraction (FPF) of 53%. When particles transition from regular shapes to irregular blocks, a decrease of 1 micron in particle size results in an approximate 20% increase in FPF. Moreover, the FPF of PMB particles combined with smooth-surfaced lactose is approximately 10% less than that of PMB particles combined with rough-surfaced mannitol. The bioavailability of PMB DPI reached a peak of 77.46% within 10 minutes. In a murine model of acute lung infection, treatment with PMB DPI significantly reduced the bacterial load in lung tissues compared to the control group, with no observed fatalities, in contrast to the outcomes of intravenous PMB administration. In summary, particles with reduced size and increased sphericity displayed a greater FPF led to enhanced therapeutic efficacy and safety.
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