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Inhaled antibiotics for the treatment of pneumonia

Matthew P Schreiber1, Andrew F Shorr

  • 1Section of Pulmonary, Critical Care, and Respiratory Services, MedStar Washington Hospital Center, Washington, District of Columbia, USA.

Current Opinion in Pulmonary Medicine
|December 19, 2018
PubMed
Abstract

Insights

Recent trials on inhaled antibiotics for severe pneumonia show mixed results. Current evidence does not support routine use of inhaled amikacin in ventilated patients, but it may be useful when other options are limited.

Area of Science:

  • Pulmonary Medicine
  • Infectious Diseases
  • Critical Care

Background:

  • Severe pneumonia, particularly gram-negative pneumonia in ventilated patients, presents significant treatment challenges.
  • The exploration of novel drug delivery methods, such as inhaled antibiotics, is crucial for improving patient outcomes.

Purpose of the Study:

  • To review recent clinical trial developments regarding inhaled antibiotics for severe pneumonia.
  • To assess the efficacy and safety of aerosolized antibiotics in treating gram-negative pneumonia in mechanically ventilated individuals.

Main Methods:

  • Analysis of three recent randomized controlled trials (RCTs) investigating inhaled amikacin for gram-negative pneumonia.
  • Inclusion of both single-center and multicenter, blinded and non-blinded study designs.

Main Results:

  • One single-center, non-blinded study suggested a potential benefit of inhaled amikacin for resistant gram-negative infections.
  • Two large multicenter, blinded trials found no significant benefit when nebulized amikacin was used as an adjunctive therapy for severe gram-negative pneumonia.

Conclusions:

  • Current high-quality clinical trial data do not support the routine administration of inhaled amikacin for pneumonia in ventilated patients.
  • A potential role for aerosolized antibiotics may exist in specific clinical scenarios, particularly when conventional treatment options are exhausted.

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