Nebulized Ceftazidime and Amikacin in Ventilator-associated Pneumonia caused by Pseudomonas Aeruginosa.
Am J Respir Crit Care Med. 2011 Apr 7;
Authors: Lu Q, Yang J, Liu Z, Gutierrez C, Aymard G, Rouby JJ,
RATIONALE: In experimental pneumonia, nebulization of antibiotics provides high lung tissue concentrations and rapid bacterial killing. OBJECTIVES: To assess efficacy and safety of nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. METHODS: Forty patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa were included in a randomized comparative phase II trial. Twenty patients infected by susceptible or intermediate strains, received nebulized ceftazidime (15 mg.kg-1.3h-1) and amikacin (25 mg.kg-1.day-1). Seventeen patients infected by susceptible strains received intravenous ceftazidime (90 mg.kg-1.day-1, continuous administration) and amikacin (15 mg.kg-1.day-1). In 3 patients infected by intermediate strains, amikacin was replaced by ciprofloxacin (400 mg.12 h-1). MEASUREMENTS AND MAIN RESULTS: After 8 days of antibiotic administration, aerosol and intravenous groups were similar in terms of successful treatment (70% vs 55%), treatment failure (15% vs 30 %) and superinfection by other micoorganisms (15% vs 15%). Antibiotic-induced changes in lung computed tomography aeration were not different between groups (increase in gas volume:159±460 ml vs 251±583 ml; decrease in tissue volume: -58 (-77 - 25) ml vs -89 (-139 - 5) ml). Acquisition of per-treatment antibiotic resistance was observed exclusively in intravenous group. In aerosol group, 4 patients infected by intermediate strains were successfully treated. Nebulization induced an obstruction of expiratory filter in 3 patients. The obstruction caused cardiac arrest in 1 patient who fully recovered after brief cardiopulmonary resuscitation. CONCLUSION: Nebulization and intravenous infusion of ceftazidime and amikacin provide similar efficiency for treating ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Nebulization is efficient against intermediate strains and may prevent per-treatment acquisition of antibiotic resistance.
PMID: 21474643 [PubMed - as supplied by publisher]