TY - JOUR T1 - Inhaled Tobramycin for Treatment of Ventilator-Associated Pneumonia: The Interplay of Patient, Drug, and Device JF - Respiratory Care SP - 151 LP - 153 DO - 10.4187/respcare.09852 VL - 67 IS - 1 AU - Rajiv Dhand Y1 - 2022/01/01 UR - http://rc.rcjournal.com/content/67/1/151.abstract N2 - Inhalation of antibiotics has had a long and checkered history. After their introduction in the 1940s, the use of inhaled antibiotics was abandoned for many decades because indiscriminate and inappropriate use led to excess mortality due to pneumonia with multidrug-resistant (MDR) organisms.1 Several factors contributed to a renewed interest in use of inhaled antibiotics for treatment of ventilator-associated pneumonia (VAP), including improved understanding of aerosol delivery in mechanically ventilated patients and the availability of more efficient aerosol-generating devices, reported success with use of inhaled antibiotics in patients with cystic fibrosis, and the emergence of MDR organisms that failed to respond to systemically administered antibiotics.2 Currently, inhaled antibiotics are frequently employed as adjuncts to systemic antibiotics for treatment of VAP.3The potential benefits of inhaled antibiotics in patients with VAP are that aerosolization through the artificial airway ensures direct delivery to the site of infection, with high lung concentrations but low plasma concentrations, which minimizes the risk of systemic toxicity.4,5 The ability of inhaled antibiotics to penetrate biofilms and limit Quorum sensing is thought to be an advantage over systemically administered antibiotics.6,7In contrast, systemically administered antibiotics have a narrow therapeutic window, and combining the use of inhaled antibiotics with systemic antibiotics has the potential to reduce overall use and duration of systemic antibiotic therapy.4,5 The combined use of inhaled and systemic antibiotics could also reduce selection pressure for emergence of MDR organisms.8 However, combining inhaled and systemic … Correspondence: Rajiv Dhand MD FAARC, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, U114, Knoxville, TN 37920. E-mail: rdhand{at}utmck.edu ER -