CHEST Guidelines-Rebuttal-From-Dr-Wunderink_2017

Rebuttal-From-Dr-Wunderink_2017_chest (2)

Pdf Summary

The text discusses the potential benefits and current challenges associated with using aerosolized antibiotics as adjunctive therapy for bacterial lower respiratory tract infections (BLRTIs), particularly in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Aerosol therapy could offer advantages over single-agent treatments by potentially minimizing treatment duration and reducing the development of antibiotic-resistant bacteria. However, the current verdict on their use remains "not proven" due to the lack of rigorous clinical trial evidence meeting FDA standards.<br /><br />Several trials are underway to evaluate the efficacy of these treatments, but until more definitive results are available, the use of aerosolized antibiotics remains primarily off-label. The text highlights the critical issues surrounding the current antibiotic resistance crisis, partly due to pharmaceutical companies’ reluctance to invest in new antibiotics and the mistaken belief that pneumonia is always a preventable and treatable complication of hospitalization.<br /><br />Experts argue that while aerosolized antibiotics and other novel approaches like monoclonal antibodies and narrow-spectrum antibiotics provide exciting opportunities, the current state of antibiotics for HAP/VAP is inadequate, particularly given the high rates of clinical failure and the rise of drug-resistant strains. There’s a call for continued exploration of innovative therapies to effectively address antibiotic resistance and improve patient outcomes. The need for new treatment modalities is emphasized as conventional antibiotics and stewardship efforts alone may not be sufficient to significantly decrease the mortality and morbidity associated with resistant infections. The discussion underlines the imperative of continued research and development in this area to change the current "not yet proven" status of these therapies.

Keywords

aerosolized antibiotics

bacterial lower respiratory tract infections

hospital-acquired pneumonia

ventilator-associated pneumonia

antibiotic resistance

clinical trials

off-label use

monoclonal antibodies

narrow-spectrum antibiotics

innovative therapies