CHEST Guidelines-Rebuttal-From-Dr-Kollef_2017

Rebuttal-From-Dr-Kollef_2017_chest

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The document highlights the ongoing crisis of antibiotic resistance, particularly in treating ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP). Despite significant challenges, the pharmaceutical industry's reluctance to invest in new antibiotics limits treatment advancements. Patients often mistakenly believe that infections like pneumonia are preventable, leading to unrealistic expectations about treatment outcomes.<br /><br />Traditional methods, such as developing new antibiotics and following pharmacokinetic/pharmacodynamic protocols, may slow resistance but will unlikely enhance patient outcomes. Novel alternative treatments include aerosolized antibiotics and adjunctive therapies like monoclonal antibodies, rapid diagnostic platforms for antibiotic susceptibility, and narrow-spectrum antibiotics targeting specific pathogens.<br /><br />Dr. Marin H. Kollef's rebuttal points out that antibiotic resistance significantly impacts outcomes in infections like VAP. In the US, over 700,000 healthcare-associated infections annually occur, many involving antibiotic-resistant bacteria. The rising prevalence of these resistant strains in Europe adds to the global burden.<br /><br />Aerosolized antibiotics offer promise in treating VAP, especially with resistant pathogens. However, prudent use is necessary, often hindered by inadequate systemic antibiotic delivery, incorrect dosing, and overuse without solid clinical support.<br /><br />New antibiotics approved by the US Food and Drug Administration, alongside developing vaccines and immunotherapies, potentially address multidrug-resistant gram-negative bacteria (MDR GNB). Guided by clinical trials, aerosolized antibiotics can become a valuable treatment component if used in salvageable patients with genuine infections, avoiding unnecessary antibiotic resistance escalation.<br /><br />In summary, innovative treatments, including aerosolized antibiotics paired with optimized clinical practices, offer hope amid the antibiotic resistance crisis. This approach potentially improves patient outcomes and curtails the spread of resistance, provided they are based on well-supported clinical evidence.

Keywords

antibiotic resistance

ventilator-associated pneumonia

hospital-acquired pneumonia

aerosolized antibiotics

monoclonal antibodies

rapid diagnostic platforms

narrow-spectrum antibiotics

multidrug-resistant bacteria

pharmaceutical industry

clinical trials