title: Should Aerosolized Antibiotics Be Used to Treat Ventilator-Associated Pneumonia?
abstract: In patients with ventilator-associated pneumonia, systemic use of antibiotics is the cornerstone of medical management. Supplemental use of aerosolized antibiotics with intravenous antibiotics in both experimental and clinical studies has been shown to have the following pharmacologic benefits: (1) aerosolized antibiotics reach the infected lung parenchyma without crossing the pulmonary alveolar capillary barrier; (2) aerosolized antibiotics increase anti-bacterial efficacy through increased local antibiotic concentration; and (3) aerosolized antibiotics decrease systemic toxicity. These benefits may be particularly beneficial to treat pneumonia caused by multidrug-resistant pathogens. Clinical data on the benefits of aerosolized antibiotics are more limited. Studies to date have not clearly shown improvements in time to extubation, mortality, or other patient-centered outcomes. At present, amikacin, colistin, and ceftazidime are the most frequently used and studied aerosolized antibiotics. This review summarizes the characteristics of aerosolized antibiotics, reviews the advantages and disadvantages of using aerosolized antibiotics, and calls for future investigations based on animal study data.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Changsheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. lberra@partners.org.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Berra
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and the Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D000280:Administration, Inhalation; D000583:Amikacin / Q000008:administration & dosage; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002442:Ceftazidime / Q000008:administration & dosage; D003091:Colistin / Q000008:administration & dosage; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D000583:Amikacin; D002442:Ceftazidime; D003091:Colistin
keywords: aerosol; antibiotics; delivery device; mechanical ventilation; ventilator-associated pneumonia