The following is a summary of “Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia,” published in the November 2023 issue of Critical Care by Ehrmann et al.

Researchers conducted a retrospective study to determine whether preventive inhaled antibiotics could lower the incidence of ventilator-associated pneumonia.

They conducted a multicenter, double-blind, randomized, controlled, superiority trial in critically ill adults. People on prolonged mechanical ventilation for at least 72 hours were given either inhaled amikacin (20 mg/kg of ideal body weight daily) or a placebo for 3 days. The primary outcome was the occurrence of a first episode of ventilator-associated pneumonia within 28 days of follow-up. Safety assessments were conducted.

The results showed 850 patients, with 847 included in the analyses (417 in the amikacin group and 430 in the placebo group). In both groups, 81% in the amikacin group and 83% in the placebo group received all three daily nebulizations. By day 28, ventilator-associated pneumonia occurred in 15% of the amikacin group and 22% of the placebo group (difference in restricted mean survival time, 1.5 days; 95% CI, 0.6 to 2.5; P=0.004). Infection-related ventilator-associated complications were lower in the amikacin group (18%) compared to the placebo group (26%) (hazard ratio, 0.66; 95% CI, 0.50 to 0.89). Trial-related serious adverse effects were observed in 1.7% of the amikacin group and 0.9% of the placebo group.

They concluded that In a 28-day follow-up study, a 3-day course of inhaled amikacin effectively reduced the incidence of ventilator-associated pneumonia among patients mechanically ventilated for at least 3 days.

Source: nejm.org/doi/full/10.1056/NEJMoa2310307