CHEST Guidelines--strong-COUNTERPOINT---strong--Should-Inhaled-Anti (1)

-strong-COUNTERPOINT---strong--Should-Inhaled-Anti (1)

Pdf Summary

In the article by Dr. Marin H. Kollef, the routine use of inhaled antibiotic therapy for bacterial lower respiratory tract infections (BLRTIs) in ICU settings is questioned, primarily due to the increase in antibiotic resistance linked to heightened consumption of antibiotics. Administering appropriate antibiotic therapy in critically ill patients with confirmed infections can reduce mortality rates; however, antibiotics are frequently prescribed even in the absence of bacterial infections.<br /><br />BLRTIs, common in mechanically ventilated patients, lead to the use of antibiotic treatments like those for ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Yet, systemic antibiotic administration often results in inadequate pulmonary penetration, fostering resistance. Aerosolized antibiotics have been developed to address this, but their efficacy remains uncertain. Currently available nebulizers have limitations; particle sizes are often too large, preventing effective delivery to distal lung units. <br /><br />Studies have shown mixed results. For example, tigecycline was linked to increased mortality and ceftobiprole was found inferior to other treatments, often due to underdosing. While some evidence indicates that aerosolized antibiotics like colistin might lead to better clinical cure rates, significant concerns about resistance, especially with multidrug-resistant (MDR) bacteria, persist. Plasmid-mediated colistin resistance has been noted in countries like China and India, where its use has increased.<br /><br />Despite the absence of robust evidence supporting their routine use, aerosolized antibiotics are increasingly utilized, particularly in regions with high MDR bacteria prevalence. There is a strong call for additional well-powered randomized controlled trials to determine their effectiveness and safety. Until rigorous evidence and regulatory approval are acquired, the routine use of inhaled antibiotics in BLRTIs remains a practice not yet proven.

Keywords

inhaled antibiotics

bacterial lower respiratory tract infections

ICU settings

antibiotic resistance

ventilator-associated pneumonia

aerosolized antibiotics

multidrug-resistant bacteria

nebulizers

colistin resistance

randomized controlled trials