Ventilator-associated Infection: The Role for Inhaled Antibiotics

Lucy B. Palmer

Disclosures

Curr Opin Pulm Med. 2015;21(3):239-249. 

In This Article

Clinical Trials for Treating Ventilator-associated Tracheobronchitis and/or Ventilator-associated Pneumonia

A description of the earliest evidence supporting the use of inhaled antimicrobials was performed by Ioannidou et al.[37] in a meta-analysis of small randomized controlled trials (RCTs) done from 1950 to 2007. The clinical efficacy of topical administration (aerosolization or instillation) with or without concurrent usage of systemic antibiotics for treatment of VAP was examined. There were only five RCTs[38–42] with a combined total of 176 patients suitable for analysis. Antibiotics used included tobramycin, sisomycin, and gentamicin. In four of the five trials, the aerosolized antibiotic was adjunctive to intravenous (i.v.) therapy.[39–42] This meta-analysis demonstrated that patients receiving aerosolized or instilled antibiotics had higher rates of resolution of signs and symptoms of VAP (clinical diagnosis), intention-to-treat fixed-effect model: [odds ratio (OR) 2.39, 95% confidence interval (CI) 1.29–4.44]; random-effect model (OR 2.75, 95% CI 1.06–7.17), and when analyzed for clinically evaluable patients had an OR of 3.14 (95% CI 1.48–6.70). There were no statistically significant differences between the therapeutic regimens for mortality or toxicity.

More recent studies are shown in Table 2. This table describes the method of delivery of aerosol, and the clinical and microbial effects of therapy.

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