Administration of antimicrobials via the respiratory tract for the treatment of patients with nosocomial pneumonia: a meta-analysis

• Published in: Journal of antimicrobial chemotherapy 2007-12, Vol.60 (6), p.1216-1226
• Main Authors: Ioannidou, Eleni, Siempos, Ilias I., Falagas, Matthew E.
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Biomedical research; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - mortality; General aspects; Gram-Negative Bacterial Infections - drug therapy; Gram-Negative Bacterial Infections - microbiology; Gram-Negative Bacterial Infections - mortality; healthcare-associated pneumonia; Human infectious diseases. Experimental studies and models; Humans; ICU-acquired pneumonia; Infectious diseases; Intensive Care Units; Medical sciences; Meta-analysis; Microbiology; Pharmacology. Drug treatments; Pneumonia; Pneumonia - drug therapy; Pneumonia - microbiology; Pneumonia - mortality; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - microbiology; Pneumonia, Ventilator-Associated - mortality; Randomized Controlled Trials as Topic; Respiratory System - drug effects; Respiratory therapy; respiratory tract infections; Treatment Outcome; ventilator-associated pneumonia
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkm385

Background Aerosolized antibiotics are a widely recognized treatment for patients with cystic fibrosis (CF). We sought to clarify their role in the treatment of non-CF patients with nosocomial pneumonia by performing a meta-analysis of randomized controlled trials (RCTs) that compared administration of antimicrobials via the respiratory tract (with or without concurrent usage of systemic antibiotics) with control treatment. Methods An extensive search of PubMed, Scopus, Cochrane Central Register of Controlled Trials, Current Contents and bibliographies from retrieved publications was made. Results Five RCTs were included in the meta-analysis. Administration of antimicrobials via respiratory tract (either inhaled or endotracheally instilled) as opposed to control was associated with better treatment success in intention-to-treat [fixed effect model: odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.29–4.44; random effects model: OR = 2.75, 95% CI 1.06–7.17] and in clinically evaluable patients (fixed effect model: OR = 3.14, 95% CI 1.48–6.70; random effects model: OR = 3.07, 95% CI 1.15–8.19). There were no statistically significant differences between therapeutic regimens regarding all-cause mortality (fixed effect model: OR = 0.84, 95% CI 0.43–1.64; random effects model: OR = 0.71, 95% CI 0.27–1.88), microbiological success (fixed effect model: OR = 2.06, 95% CI 0.91–4.68; random effects model: OR = 2.23, 95% CI 0.64–7.71) and toxicity (fixed effect model: OR = 0.34, 95% CI 0.04–2.53; random effects model: OR = 0.36, 95% CI 0.04–3.16). Conclusions The limited available evidence seems not to preclude a benefit from the administration of antimicrobial agents via the respiratory tract for treating nosocomial pneumonia.