The role of aerosolized antimicrobials in the treatment of ventilator-associated pneumonia.

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.