CHEST Guidelines-Rebuttal-From-Dr-Wunderink_2017

Rebuttal-From-Dr-Wunderink_2017_chest (1)

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The discussion focuses on aerosol therapy as an advantage over single agents for treating bacterial lower respiratory tract infections (BLRTIs), particularly hospital-acquired and ventilator-associated pneumonia (HAP/VAP). There is an ongoing debate on the efficacy of adjunctive aerosolized antibiotics. Despite the theoretical benefits, no clinical trials have met the FDA's criteria for approval, which raises skepticism among medical professionals about their clinical value, leading them to consider the current verdict as "not proven."<br /><br />The text refers to clinical trials conducted by two pharmaceutical companies (NCT01969799, NCT01799993) that aim to meet these standards. The importance of reducing treatment duration and the emergence of resistant bacteria through aerosol antibiotics is emphasized.<br /><br />Richard G. Wunderink, MD, acknowledges the challenges of proving aerosol antibiotics' effectiveness but points to the "guilty" verdict for current antibiotic treatments, citing high clinical failure rates and significant antibiotic resistance. He criticizes the pharmaceutical industry's reluctance to invest in new antibiotics and addresses misconceptions about pneumonia being fully preventable. Wunderink stresses a need for alternative solutions like monoclonal antibodies, extremely narrow-spectrum antibiotics, and advanced diagnostic platforms.<br /><br />Marin H. Kollef, MD, highlights the significant concern over antibiotic resistance, particularly in multidrug-resistant (MDR) bacteria, contributing to infections such as VAP. In the United States, antibiotic-resistant infections notably impact critically ill patients. He suggests considering aerosolized antibiotics for treating VAP involving resistant pathogens, inadequate drug delivery, or parenteral drug toxicities, while acknowledging the complexity of the issue and the need for continued exploration of effective treatments.<br /><br />Both professionals agree that despite the current challenges, further research is needed to improve treatment outcomes for HAP/VAP and address the rise of antibiotic-resistant infections.

Keywords

aerosol therapy

bacterial lower respiratory tract infections

hospital-acquired pneumonia

ventilator-associated pneumonia

antibiotic resistance

aerosolized antibiotics

clinical trials

Richard G. Wunderink

Marin H. Kollef

multidrug-resistant bacteria