CHEST Guidelines-Rebuttal-From-Dr-Kollef_2017

Rebuttal-From-Dr-Kollef_2017_chest (1)

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The document discusses the ongoing crisis in antibiotics, particularly regarding the treatment of ventilator-associated pneumonia (VAP) and hospital-associated pneumonia (HAP). It underscores the reluctance of the pharmaceutical industry to invest in new antibiotics, which has contributed to antibiotic resistance. It highlights the mistaken belief among patients that pneumonia is entirely preventable and treatable, a notion challenged by the rise of extremely drug-resistant bacteria.<br /><br />The text criticizes the expectation that new antibiotics and optimized treatment protocols will significantly improve outcomes for patients with VAP/HAP. It argues that while these measures may slow resistance development, they are unlikely to reduce morbidity or mortality significantly. Alternative treatments, such as aerosolized antibiotics, adjunctive passive immunization, and rapid diagnostic tools, are suggested as potential avenues for improving patient outcomes.<br /><br />Dr. Marin H. Kollef elaborates on the potential benefits and drawbacks of aerosolized antibiotics for treating VAP. While they might be an essential treatment for multidrug-resistant (MDR) gram-negative bacteria, there is concern about inappropriate use without clinical evidence, which could drive further resistance. The document also mentions recent advances in new antibiotics, vaccines, and immunotherapies against MDR pathogens, which present emerging options apart from aerosolized therapies.<br /><br />Overall, the text argues that to effectively combat VAP and HAP and curb antibiotic resistance, there needs to be a shift towards better diagnostics, new treatment modalities, and appropriate use of existing and emerging antibiotic therapies. Regular clinical assessments and adequate stewardess practices are recommended to prevent indiscriminate antibiotic use and resistance proliferation, ensuring the best patient outcomes while reducing global antibiotic resistance.

Keywords

antibiotic resistance

ventilator-associated pneumonia

hospital-associated pneumonia

pharmaceutical industry

drug-resistant bacteria

aerosolized antibiotics

passive immunization

rapid diagnostic tools

multidrug-resistant bacteria

antibiotic stewardship