Preventive use of amikacin can reduce cases of ventilator-acquired pneumonia

Taking amikacin by inhalation could prevent pneumonia in patients on ventilators, a new study found. Given for three consecutive days to intensive care patients, the antibiotic reduced cases of ventilator-acquired pneumonia (VAP) by 32%.“Despite decades of research and the implementation of preventive measures against ventilator-acquired pneumonia (reduced sedation and early weaning, position change, endotracheal tube management and oral care), cases remain unacceptably high,” note the authors of the study whose results appeared in the New England Journal of Medicine.Since the infection generally develops after more than 48 hours of intubation and peaks at seven days of ventilation, the researchers wanted to take advantage of this window of therapeutic opportunity to try to prevent the progression of pneumonia. The selected patients had to have been on artificial respirators for at least 72 hours. Certain criteria resulted in the exclusion of a patient from the study; if ventilation had been in place for more than 96 hours, extubation was planned within 24 hours or VAP was suspected or confirmed.The randomized, double-blind study led by French researchers was conducted on 850 patients. Among them, 420 received amikacin by nebulization at a dose of 20 mg per kilogram of body weight. The 430 patients who were part of the control group received a 0.9% solution of sodium chloride.Read: Why Viagra may be useful in treating lung diseasesFor three consecutive days, amikacin or sodium chloride was nebulized for around 40 minutes. Then, the researchers observed the cases of pneumonia that occurred until day 28. After this period, 62 patients on amikacin (15%) and 95 patients on placebo (22%) had contracted ventilator-associated pneumonia. Typically, cases of pneumonia in the placebo group occurred a day earlier, with a median of nine days after intubation. However, the study could not determine whether cases of VAP avoided by antibiotics resulted in a reduction in the length of stay in intensive care or in fewer deaths.On the other hand, among all those who developed VAP, it was noted that the duration of ventilation and the stay in the intensive care unit were twice as high compared to those who did not develop it.Since only 22% of patients had bacterial colonization when starting the randomized study, researchers are now evaluating the possibility of starting preventive antibiotics after four or five days of ventilation.There are other antibiotics administered by the respiratory tract that have the potential to reduce the incidence of ventilator-associated pneumonia. A meta-analysis bringing together six studies carried out on a small number of patients obtained similar conclusions. Gentamicin, colistin and ceftazidime were notably administered by nebulization for seven to 15 days with a lower number of cases of pneumonia compared to the control group.

Preventive use of amikacin can reduce cases of ventilator-acquired pneumonia

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