CHEST Guidelines-Rebuttal-From-Dr-Kollef_2017

Rebuttal-From-Dr-Kollef_2017_chest (2)

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The document discusses the ongoing crisis of antibiotic resistance, highlighting the reluctance and inability of the pharmaceutical industry to develop new antibiotics to treat resistant infections effectively. It underscores a common misconception that pneumonia, particularly in mechanically ventilated or hospitalized patients, is entirely preventable and treatable, which is not always the case, especially for ventilator-associated pneumonia (VAP). Recent media coverage of drug-resistant bacteria and governmental actions have raised awareness about the complexities of treating pneumonia.<br /><br />The text discusses the challenges with current treatments and the minimal potential of new developments in improving outcomes for hospital-acquired pneumonia (HAP) and VAP, comparing them to what Einstein described as insanity: doing the same thing repeatedly and expecting different results. Potential alternatives to antibiotic treatments, like adjunctive passive immunization and narrow-spectrum antibiotics, are proposed.<br /><br />Moreover, it highlights aerosolized antibiotics as a potential treatment option for VAP, particularly for dealing with multidrug-resistant (MDR) bacteria. However, its use should be considered carefully due to the possibility of inducing further resistance. Besides antibiotics, new vaccines and immunotherapies are being developed to counter MDR bacteria, like a vaccine targeting Pseudomonas aeruginosa, which is in clinical trials.<br /><br />In summary, the document advocates for the careful use and trial-backed validation of new antibiotics and supportive treatments for VAP to avoid reinforcing global antibiotic resistance. The need for ongoing research into alternative therapies and the optimization of current methods is emphasized to ensure effective treatment of bacterial infections without exacerbating antibiotic resistance.

Keywords

antibiotic resistance

pharmaceutical industry

ventilator-associated pneumonia

hospital-acquired pneumonia

drug-resistant bacteria

aerosolized antibiotics

multidrug-resistant bacteria

adjunctive passive immunization

Pseudomonas aeruginosa vaccine

alternative therapies