Inhaled antibiotic therapy for ventilator-associated tracheobronchitis and ventilator-associated pneumonia: an update

Adv Ther. 2011 Sep;28(9):728-47. doi: 10.1007/s12325-011-0051-z. Epub 2011 Aug 8.


Ventilator-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in mechanically-ventilated patients in the Intensive Care Unit (ICU). Ventilator-associated tracheobronchitis (VAT) was previously believed to be an intermediate stage between colonization of the lower respiratory tract and VAP. More recent data, however, suggest that VAT may be a separate entity that increases morbidity and mortality, independently of the occurrence of VAP. Some, but not all, patients with VAT progress to develop VAP. Although inhaled antibiotics alone could be effective for the treatment of VAP, the current consensus of opinion favors their role as adjuncts to systemic antimicrobial therapy for VAP. Inhaled antibiotics are increasingly employed for salvage therapy in patients with VAP due to multi-drug resistant Gram-negative bacteria. In contrast to VAP, VAT could be effectively treated with inhaled antibiotic therapy alone or in combination with systemic antimicrobials.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Aerosols
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / pharmacokinetics
  • Bronchitis / drug therapy*
  • Bronchitis / etiology
  • Bronchitis / microbiology
  • Cross Infection / drug therapy
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Lung / metabolism
  • Nebulizers and Vaporizers
  • Pneumonia, Ventilator-Associated / drug therapy*
  • Pneumonia, Ventilator-Associated / microbiology
  • Tracheitis / drug therapy*
  • Tracheitis / etiology
  • Tracheitis / microbiology
  • Ventilators, Mechanical / adverse effects*


  • Aerosols
  • Anti-Bacterial Agents