Abstract
The increasing emergence of multidrug-resistant organisms creates a therapeutic challenge
for physicians treating ventilator-associated respiratory infections. As the production
of new systemic antibiotics lags far behind the emergence of worsening antibiotic
resistance, intensivists are turning to inhaled antibiotics to use as adjunctive therapy.
When given properly, these drugs can provide high concentrations of drug in the lung
that could not be achieved with intravenous antibiotics without significant systemic
toxicity. This review summarizes current evidence describing the use of inhaled antibiotics
for the treatment of bacterial ventilator-associated infections. Inhaled adjunctive
therapy has been described in numerous small nonrandomized studies and in six recent
randomized placebo-controlled trials. Inhaled therapy has also been used to treat
ventilator-associated tracheobronchitis. These preliminary data suggest aerosolized
delivery of antimicrobials may effectively treat resistant pathogens with high minimum
inhibitory concentrations when used in time-limited protocols and delivered with devices
known to deposit antibiotics in the area of infection. Large, multisite, clinical,
randomized placebo-controlled studies are needed to confirm these data.
Keywords
inhaled antibiotics - ventilator-associated tracheobronchitis - ventilator-associated
pneumonia - bacterial resistance - colistin - amikacin
