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Intubation-mediated Intratracheal (IMIT) Instillation: A Noninvasive, Lung-specific Delivery System
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Why don't we have more inhaled antibiotics to treat ventilator-associated pneumonia?

D A Sweeney1, A C Kalil2

  • 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego, CA, USA.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|April 30, 2019
PubMed
Abstract

Insights

Inhaled antibiotics (IA) show promise for treating ventilator-associated pneumonia (VAP), especially for multidrug-resistant infections. Future research should focus on patients with limited treatment options to establish IA as a standard therapy.

Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Pharmacology

Background:

  • Rising rates of ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) organisms or infections with limited treatment options necessitate alternative strategies.
  • The development of new antimicrobials has lagged, prompting interest in inhaled antibiotics (IA) as a viable management option.

Purpose of the Study:

  • To review existing evidence on the efficacy of IA in treating VAP.
  • To explore the potential for adjunctive IA to become a standard therapy for specific VAP patient populations.

Main Methods:

  • A meta-analysis conducted by the 2016 IDSA/ATS Hospital-acquired Pneumonia Guideline Committee.
  • A comprehensive literature search of PubMed and clinicaltrials.gov for recent randomized trials of IA in VAP treatment.

Main Results:

  • Initial meta-analysis supported IA for VAP due to Gram-negative bacilli susceptible only to aminoglycosides or polymyxins (RR 1.29; 95% CI 1.13-1.47).
  • Two subsequent trials did not show a benefit, but an updated meta-analysis (n=11) including these trials suggests a benefit for MDR and difficult-to-treat VAP (RR 1.2; 95% CI 1.05-1.57).

Conclusions:

  • Patients with VAP and limited intravenous antibiotic choices are the most likely candidates to benefit from adjunctive IA.
  • Further research should target these specific patient groups, and comparative studies on nebulizer devices are needed.
Keywords:
AerosolizedAntibioticsInhaledVentilator-associated

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