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Research ArticleSymposium Papers

The Role of Aerosolized Antimicrobials in the Treatment of Ventilator-Associated Pneumonia

Rajiv Dhand
Respiratory Care July 2007, 52 (7) 866-884;
Rajiv Dhand
Division of Pulmonary, Critical Care, and Environmental Medicine, Department of Internal Medicine, University of Missouri–Columbia, Columbia, Missouri, and with Harry S Truman Veterans Affairs Hospital, Columbia, Missouri
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Abstract

The ability to deliver high concentrations of antimicrobial agents directly to the site of pneumonia is attractive, especially with the availability of high-efficiency nebulizers. A major focus of inhaled antimicrobial therapy has been to prevent and treat ventilator-associated pneumonia (VAP). VAP occurs commonly in mechanically ventilated patients and is associated with significant morbidity and high mortality. Moreover, the emergence of VAP due to multiple-drug-resistant Gram-negative organisms that are resistant to any form of systemic antimicrobial therapy has provided an impetus to explore inhaled antimicrobial treatment as an adjunct to systemic therapy. Tobramycin solution for inhalation and colistimethate sodium have been formulated for delivery via inhalation. Although these agents are being increasingly employed in intensive care units, the intricacies involved in their use are not appreciated by many clinicians. This review discusses the role of these agents in the prevention and treatment of VAP, with an emphasis on some of the problems associated with their use. Further research is needed to support the use of inhaled antimicrobial therapy in patients with VAP.

  • antimicrobial
  • antibiotics
  • pneumonia
  • aerosol
  • ventilator-associated pneumonia
  • VAP
  • mechanical ventilation
  • tobramycin
  • colistimethate sodium

Footnotes

  • Correspondence: Rajiv Dhand MD FAARC, Division of Pulmonary, Critical Care, and Environmental Medicine, MA-421 Health Sciences Center, DC043.00, 1 Hospital Drive, University of Missouri–Columbia, Columbia MO 65212. E-mail: dhandr{at}health.missouri.edu.
  • The author presented a version of this paper at the 22nd Annual New Horizons Symposium at the 52nd International Respiratory Congress of the American Association for Respiratory Care, held December 11–14, 2006, in Las Vegas, Nevada.

  • The author reports no conflicts of interest related to the content of this paper.

  • This work was supported by the Veterans Affairs Research Service.

  • Copyright © 2007 by Daedalus Enterprises Inc.
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Respiratory Care: 52 (7)
Respiratory Care
Vol. 52, Issue 7
1 Jul 2007
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The Role of Aerosolized Antimicrobials in the Treatment of Ventilator-Associated Pneumonia
Rajiv Dhand
Respiratory Care Jul 2007, 52 (7) 866-884;

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The Role of Aerosolized Antimicrobials in the Treatment of Ventilator-Associated Pneumonia
Rajiv Dhand
Respiratory Care Jul 2007, 52 (7) 866-884;
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Keywords

  • antimicrobial
  • antibiotics
  • pneumonia
  • aerosol
  • ventilator-associated pneumonia
  • VAP
  • mechanical ventilation
  • tobramycin
  • colistimethate sodium

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