Inhaled antibiotics for nosocomial pneumonia

Pneumonia, especially the more severe forms, is associated with considerable morbidity and mortality. Systemic use of antibiotics is the cornerstone of the management of pneumonia in all patients, including critical care patients. Several adjunctive strategies have been suggested to improve management. Notably, localized treatment in the lungs via the instillation or inhalation or nebulization of antibiotics may offer the theoretical advantage of a therapy which targets the lung while it has no systematic effects. However, the use of inhaled antibiotics is controversial. Methods of antibiotic delivery and microbiology vary between available studies and despite the favorable profile of this strategy, concerns have been raised by early data that this therapeutic approach may increase the appearance of resistant bacteria. In this report, we reviewed available evidence from animal and human clinical studies in respect of the role of inhaled antibiotic therapy in pneumonia. In most studies, pneumonia cure rates were found to be comparable to that of systemic antibiotic only therapy and occasionally better. Inhaled antibiotic therapy was found to have an acceptable safety profile by avoiding systemic toxicity; despite previous concerns regarding the emergence of antimicrobial resistance, recent studies did not support such concerns. However, in respect of the sparity of data larger randomized trial are needed to shed more light in this promising form of treatment.