Pneumonia induced by Klebsiella pneumoniae (K. pneumoniae) is a grave pathological state that bears profound implications for morbidity and mortality rates. It is marked by an exaggerated inflammatory response in the lung tissue, resulting in lung damage. Accordingly, combining Levofloxacin hemihydrate (LV) with Prednisolone (PD) could potentially reduce the inflammatory response associated with severe pneumonia and save patients’ lives. Therefore, this study aimed to develop LV-loaded spanlastics (SPs)/PD buccal mucoadhesive sponge for the treatment of severe pneumonia. For LV SPs fabrication and optimization, a full 32 factorial design was utilized to examine the impact of the type of edge activator (EA) and Span 60: EA ratio on vesicle size (VS) and encapsulation efficiency percent (EE%). The optimum formula was determined by recording the minimum VS and maximum EE%. It was then tested microbiologically, followed by integration into a mucoadhesive sponge with the addition of PD, forming LV SPs/PD sponge that was evaluated via in-vivo study. The optimum LV SPs was formulation 3 (F3), which was fabricated using Tween 80 as an EA with a Span 60: EA ratio of 80:20. F3 exhibited an EE% of 92.40 ± 0.01 %, a VS of 248.60 ± 2.05 nm, highly elastic spherically shaped nanovesicles with a controlled release profile, and enhanced drug permeation. The minimum inhibitory concentration (MIC) of F3 was reduced by a factor of 8 compared to Levoxin®. Moreover, F3 revealed superiority over Levoxin® by 10, 20, and 10 percentage points increase in downregulating gyrA, gyrB, and parC gene expression in K. pneumoniae, respectively. The LV SPs/PD sponge revealed a spongy structure with well-defined pores. It had a surface pH of 6.93 ± 0.06, a swelling index of 3.52 ± 0.35, an ex-vivo mucoadhesion residence time of 3.01 ± 0.61 h, and a drug content of 97.39 ± 1.82 % for LV and 98.06 ± 1.34 % for PD. As well, the release pattern of the LV SPs/PD sponge was significantly slower than that of the F3 for LV and the Epicopred® for PD. The in-vivo study of the LV SPs/PD sponge demonstrated a prevalence effect in restoring the typical lung histology in rats. Additionally, it returns high mobility group box (HMGB)-1 and nuclear factor-kappa B (NF-қB) biomarkers to their normal levels, surpassing the effects observed with Levoxin®/Epicopred®. Collectively, the LV SPs/PD sponge might hold great potential as a promising treatment approach for the management of severe pneumonia.
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