Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study.
OBJECTIVE
To evaluate the efficacy and safety of inhaled tobramycin (TOBI) in the treatment of ventilator-associated pneumonia (VAP) in a randomized, double-blind pilot study.


METHODS
Ten patients from a cohort of 108 mechanically ventilated patients with documented clinical and bacteriological evidence of VAP caused by Pseudomonas aeruginosa or Acinetobacter spp. in the surgical and trauma intensive care units of a university teaching hospital were randomized to receive either TOBI (n = 5) or intravenous tobramycin (TOBRA; n = 5). The two groups were similar in their Acute Physiology and Chronic Health Evaluation (APACHE) score, Clinical Pulmonary Infection Score (CPIS), and Multiple Organ Dysfunction Score (MODS) prior to randomization. The primary outcome measure was resolution of pneumonia. The CPIS and MODS were used as objective indicators of clinical progress.


RESULTS
All TOBI patients had clinical resolution of VAP. Two TOBRA patients were considered failures. One had deterioration in MODS, and the other had doubling of his serum creatinine concentration. The patients treated with TOBI may have had more ventilator-free days than those receiving TOBRA, but the difference was not statistically significant owing to the small sample size (24 +/- 3 vs. 14 +/- 13 days; p = 0.12).


CONCLUSIONS
Aerosolized tobramycin for the treatment of VAP appeared safe and effective in this pilot study. A larger study is warranted to determine if aerosolized tobramycin will lead to better outcomes than intravenous tobramycin when used for the treatment of VAP.
Hallal
Ali
A
Ryder Trauma Center, Department of Surgery and Division of Infectious Diseases, Jackson Memorial Hospital, University of Miami School of Medicine, Miami, FL, USA.
Cohn
Stephen M
SM
Namias
Nicholas
N
Habib
Fahim
F
Baracco
Gio
G
Manning
Ronald J
RJ
Crookes
Bruce
B
Schulman
Carl I
CI
D018806:APACHE; D000150:Acinetobacter / Q000302:isolation & purification; D000151:Acinetobacter Infections / Q000188:drug therapy; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D010865:Pilot Projects; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D014031:Tobramycin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003404:Creatinine; D014031:Tobramycin