Indications of Aerosolized Antibiotics in Mechanically Ventilated Patients

Abstract

Ventilator-associated pneumonia (VAP) significantly increases intensive care unit morbidity, mortality, and costs. The rationale for using aerosolized antibiotics (AA) makes sense: the main advantage is the targeted drug delivery to the site of infection. AA can yield high concentrations in the lung while minimizing systemic toxicity. The ability of a drug to effectively reach the targeted area in the lung depends on a number of variables, including the type of nebulizer and the ventilator settings. The most convincing data to support the use of aerosolized antimicrobials has been generated for maintenance treatment in patients with cystic fibrosis. Although the theory is sound, there are limited data available to support the routine use of AA in mechanically ventilated patients. Clinical evidence for AA to prevent VAP is limited and conflicting. Recent data send a positive message to treat tracheobronchitis-associated pneumonia with AA. Clinical evidence that AA can treat VAP remains insufficient and multiple consensus groups recommend against treating VAP with AA. A combination of aerosolized and systematic treatment may be considered for patients with multi-drug resistance bacteria unresponsive to standard therapy. Large, appropriately designed and controlled trials with targeted antibiotics given for a short period appear to be urgently needed.