CHEST Guidelines--strong-COUNTERPOINT---strong--Should-Inhaled-Anti

-strong-COUNTERPOINT---strong--Should-Inhaled-Anti

Pdf Summary

Dr. Marin H. Kollef argues against the routine use of inhaled antibiotic therapy for treating bacterial lower respiratory tract infections (BLRTIs) in ICU settings. He highlights the historical rise of antibiotic resistance, exacerbated by the overuse of antimicrobials. The emergence of multidrug-resistant (MDR) bacteria poses significant challenges in treating BLRTIs such as ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT). Despite the potential of aerosolized antibiotics to enhance drug delivery directly to the lungs, evidence supporting their effectiveness in ICU settings remains limited and inconclusive.<br /><br />Studies concerning aerosolized antibiotics like colistin have shown some benefits but suffer from methodological weaknesses and small sample sizes. Notably, inconsistent aerosol delivery methods have resulted in varying efficacy. Moreover, the widespread uptake of aerosolized antibiotics, particularly in countries with high incidences of MDR infections, correlates with the emergence of further resistance.<br /><br />Dr. Kollef stresses the necessity for rigorous evaluations before any new antibiotic uses are normalized, given the potential for further resistance development. Current clinical trials have not yet demonstrated sufficient evidence warranting routine aerosolized antibiotic use for VAP and VAT. More comprehensive and adequately powered randomized controlled trials are necessary to determine their overall efficacy and appropriate clinical applications.<br /><br />The expansion of existing antibiotic treatments lacks robust, definitive regulatory approval, and ongoing research aims to satisfy FDA criteria for safety, efficacy, and appropriate dosing. Until reliable evidence emerges, Dr. Kollef advises caution and reserves a "not proven" verdict, underscoring the importance of preventing exacerbation of antibiotic resistance without clear benefits.

Keywords

inhaled antibiotic therapy

bacterial lower respiratory tract infections

ICU settings

antibiotic resistance

multidrug-resistant bacteria

ventilator-associated pneumonia

aerosolized antibiotics

clinical trials

antimicrobial overuse

randomized controlled trials