Is There a Role for Inhaled Antibiotics in the Treatment of Ventilator-Associated Infections?

Semin Respir Crit Care Med. 2017 Jun;38(3):359-370. doi: 10.1055/s-0037-1602743. Epub 2017 Jun 4.

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.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchitis / drug therapy
  • Bronchitis / etiology
  • Cross Infection / drug therapy
  • Drug Administration Schedule
  • Gastrointestinal Microbiome / physiology
  • Humans
  • Intensive Care Units
  • Meta-Analysis as Topic
  • Microbial Sensitivity Tests
  • Pneumonia, Ventilator-Associated / drug therapy*
  • Pneumonia, Ventilator-Associated / prevention & control
  • Randomized Controlled Trials as Topic
  • Respiration, Artificial / adverse effects
  • Review Literature as Topic
  • Tracheitis / drug therapy
  • Tracheitis / etiology

Substances

  • Anti-Bacterial Agents