CHEST Guidelines--strong-POINT---strong--Should-Inhaled-Antibiotic- (1)

-strong-POINT---strong--Should-Inhaled-Antibiotic- (1)

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This article advocates for the routine use of inhaled antibiotic therapy in treating bacterial lower respiratory tract infections (BLRTI) in intensive care unit (ICU) settings, specifically hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). It argues that aerosolized antibiotics are a rational approach due to the challenges posed by inappropriate initial therapies and the inefficiencies of intravenous (IV) treatments, especially against multidrug-resistant (MDR) pathogens like gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter species.<br /><br />The text highlights the inadequacies of current IV treatments, which often fail against MDR pathogens, emphasizing the high rates of resistance even in commonly used antibiotics. Despite combination therapies being frequently used, evidence shows they do not necessarily lead to better clinical outcomes, especially in treating HAP/VAP. The routine duration of antibiotic courses also does not significantly improve survival rates nor prevent higher recurrence within 28 days, necessitating a consideration for alternative approaches.<br /><br />Aerosolized antibiotics offer a significant advantage in that they can reach higher concentrations in the lungs compared to IV methods, thus achieving local bacterial suppression where high bacteria loads fire potential resistant mutations. Clinical data reveal promising antibiotic penetration in lung tissue and higher bacterial eradication when antibiotics like aerosolized aminoglycosides are used.<br /><br />The main barrier to widespread implementation is limited clinical experience and evaluation in randomized controlled trials (RCTs), though initial studies suggest superior bacterial eradication in patients using aerosolized treatments. The text concludes that, given the inefficacy of standard therapies and the growing prevalence of MDR organisms, inhaled antibiotics should be more widely adopted in treating ICU patients, with further development on optimal delivery methodologies.

Keywords

inhaled antibiotic therapy

bacterial lower respiratory tract infections

ICU

hospital-acquired pneumonia

ventilator-associated pneumonia

multidrug-resistant pathogens

aerosolized antibiotics

gram-negative bacteria

Pseudomonas aeruginosa

Acinetobacter species