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Updated: May 12, 2026

Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Inhaled Antibiotics to Treat Ventilator-Associated Pneumonia: A Systematic Review and Meta-Analysis
Shan Lyu1, Jian Luo2, Ping Liu3
1Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
Adjunctive inhaled antibiotics significantly improve clinical cure and microbiological eradication for ventilator-associated pneumonia (VAP). These treatments may also reduce mortality, especially in VAP-only patients, offering potential benefits over intravenous therapy.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Ventilator-associated pneumonia (VAP) poses a significant challenge in intensive care settings.
- Effective treatment strategies for VAP are crucial to improve patient outcomes and reduce mortality.
Purpose of the Study:
- To evaluate the efficacy and safety of adjunctive inhaled antibiotics in treating patients with ventilator-associated pneumonia (VAP).
- To compare inhaled antibiotics with placebo/blank and intravenous (IV) antibiotics for VAP treatment.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) and nonrandomized studies were conducted.
- Searches were performed across major databases (PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov) up to May 31, 2025.
- Data extraction, risk of bias assessment, and meta-analyses (including subgroup and meta-regression analyses) were performed using random effects models.
Main Results:
- Adjunctive inhaled antibiotics significantly improved clinical cure rates and microbiological eradication compared to placebo/blank.
- A reduction in all-cause mortality was observed, particularly in patients with VAP-only.
- Exploratory analyses suggested potential advantages over IV therapy, including shorter ventilator duration and reduced nephrotoxicity, with no significant differences in other adverse events.
Conclusions:
- Adjunctive inhaled antibiotics are effective in improving clinical cure and microbiological eradication in VAP patients, especially those with VAP-only.
- Inhaled antibiotics may offer a survival benefit and potential advantages over IV therapy, such as reduced nephrotoxicity.
- Further high-quality trials are warranted to confirm the benefits of inhaled antibiotics over existing treatments for VAP.
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