Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 100968563 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2466 (Electronic) Linking ISSN: 14712466 NLM ISO Abbreviation: BMC Pulm Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, [2001]-
    • Subject Terms:
      Pneumonia, Ventilator-Associated*/drug therapy ; Tobramycin*/administration & dosage ; Colistin*/administration & dosage ; Anti-Bacterial Agents*/administration & dosage ; Anti-Bacterial Agents*/therapeutic use; Humans ; Administration, Inhalation ; Randomized Controlled Trials as Topic ; Intensive Care Units ; Treatment Outcome ; Respiration, Artificial
    • Abstract:
      Introduction: Ventilator-associated pneumonia (VAP) presents a significant challenge in intensive care units (ICUs). Nebulized antibiotics, particularly colistin and tobramycin, are commonly prescribed for VAP patients. However, the appropriateness of using inhaled antibiotics for VAP remains a subject of debate among experts. This study aims to provide updated insights on the efficacy of adjunctive inhaled colistin and tobramycin through a comprehensive systematic review and meta-analysis.
      Methods: A thorough search was conducted in MEDLINE, EMBASE, LILACS, COCHRANE Central, and clinical trials databases ( www.
      Clinicaltrials: gov ) from inception to June 2023. Randomized controlled trials (RCTs) meeting specific inclusion criteria were selected for analysis. These criteria included mechanically ventilated patients diagnosed with VAP, intervention with inhaled Colistin and Tobramycin compared to intravenous antibiotics, and reported outcomes such as clinical cure, microbiological eradication, mortality, or adverse events.
      Results: The initial search yielded 106 records, from which only seven RCTs fulfilled the predefined inclusion criteria. The meta-analysis revealed a higher likelihood of achieving both clinical and microbiological cure in the groups receiving tobramycin or colistin compared to the control group. The relative risk (RR) for clinical cure was 1.23 (95% CI: 1.04, 1.45), and for microbiological cure, it was 1.64 (95% CI: 1.31, 2.06). However, there were no significant differences in mortality or the probability of adverse events between the groups.
      Conclusion: Adjunctive inhaled tobramycin or colistin may have a positive impact on the clinical and microbiological cure rates of VAP. However, the overall quality of evidence is low, indicating a high level of uncertainty. These findings underscore the need for further rigorous and well-designed studies to enhance the quality of evidence and provide more robust guidance for clinical decision-making in the management of VAP.
      (© 2024. The Author(s).)
    • References:
      J Crit Care. 2018 Feb;43:240-245. (PMID: 28942198)
      Semin Respir Crit Care Med. 2022 Apr;43(2):255-270. (PMID: 35042259)
      Front Med (Lausanne). 2019 May 08;6:99. (PMID: 31139628)
      Surg Infect (Larchmt). 2007 Feb;8(1):73-82. (PMID: 17381399)
      Rev Peru Med Exp Salud Publica. 2023 Jan-Mar;40(1):115-117. (PMID: 37377230)
      J Crit Care. 2021 Oct;65:133-139. (PMID: 34144265)
      BMC Pulm Med. 2016 Mar 08;16:40. (PMID: 26956371)
      Microorganisms. 2021 May 27;9(6):. (PMID: 34072189)
      Presse Med. 2000 Jan 22;29(2):76-8. (PMID: 10682031)
      Eur Respir J. 2017 Sep 10;50(3):. (PMID: 28890434)
      Crit Care. 2018 Nov 15;22(1):301. (PMID: 30442203)
      BMJ. 2008 Apr 26;336(7650):924-6. (PMID: 18436948)
      Intensive Care Med. 2020 Mar;46(3):546-548. (PMID: 31974920)
      J Crit Care. 2023 Oct;77:154315. (PMID: 37120926)
      Antimicrob Agents Chemother. 1990 Feb;34(2):269-72. (PMID: 2183716)
      J Intensive Care Med. 2023 May;38(5):418-424. (PMID: 36278257)
      J Aerosol Med Pulm Drug Deliv. 2022 Jan;35(1):11-24. (PMID: 35099284)
      J Antimicrob Chemother. 2010 Dec;65(12):2645-9. (PMID: 20876621)
      BMJ. 2011 Oct 18;343:d5928. (PMID: 22008217)
      Anaesth Crit Care Pain Med. 2023 Oct;42(5):101249. (PMID: 37217019)
    • Contributed Indexing:
      Keywords: Efficacy; Safety; Ventilator-associated pneumonia
    • Accession Number:
      VZ8RRZ51VK (Tobramycin)
      Z67X93HJG1 (Colistin)
      0 (Anti-Bacterial Agents)
    • Publication Date:
      Date Created: 20240502 Date Completed: 20240503 Latest Revision: 20240522
    • Publication Date:
      20240522
    • Accession Number:
      PMC11064396
    • Accession Number:
      10.1186/s12890-024-03032-7
    • Accession Number:
      38698403