REVIEW   Free access

Minerva Respiratory Medicine 2023 September;62(3):121-5

DOI: 10.23736/S2784-8477.23.02042-9

Copyright © 2023 EDIZIONI MINERVA MEDICA

lingua: Inglese

Inhaled antibiotics for treatment of pneumonia: gone with the wind?

Nicholas GHIONNI, Andrew F. SHORR ✉

Medstar Washington Hospital Center, Washington, DC, USA

Pneumonia is a leading cause of death and disability. Clinicians traditionally have relied upon intravenous antibiotics for the treatment of severe pneumonia. For various reasons ranging from the increasing prevalence of antibiotic resistance to the desire to be more organ specific in targeting, many have advocated for the use of inhaled antimicrobials in severe pneumonia - particularly those requiring mechanical ventilation. In addition, the American Thoracic Society and the Infectious Disease Society of America guidelines for nosocomial pneumonia suggest a role for inhaled antibiotics as adjunctive therapy. Despite this recommendation to consider inhaled agents, there remains little data supporting the efficacy of inhaled antibiotics for pneumonia in ventilated subjects. Recent randomized controlled trials have failed demonstrate any benefit of inhaled delivery. Other analyses demonstrate that there remains considerable inconsistency in drug delivery via nebulization, particularly due to the need to time drug delivery with distinct phases of the ventilatory cycle. Given the lack of clear efficacy issues and further worries about actual parenchymal drug penetration when delivered via aerosolization, it seems prudent to limit the use of this strategy.

KEY WORDS: Antibiotic prophylaxis; Inhalation; Pneumonia; Drug resistance; Ventilators, mechanical