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Oral anaerobes generate volatile sulfur compounds (VSCs) such as hydrogen sulfide and methanethiol, which may modulate inflammatory signaling and epithelial integrity within the respiratory mucosa 195 , while organic acids and tryptophan-derived metabolites produced by oral commensals may further alter microbial colonisation patterns and host immune responses in the airways 196

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Their large size, rigidity, limited aqueous solubility, and poor absorption make them poorly suited for intramuscular and nasal routes, which rely on fast absorption of drugs in systemic circulation