Effectiveness of Inhaled Antibiotics in Ventilator Associated Pneumonia: A Systematic Review and Meta-Analysis

Abstract

Inhaled antibiotics are adjunct to ventilator-associated pneumonia (VAP) therapy because they are delivered directly to the infection site of the lungs, while intravenous (IV) antibiotics work systematically. The Food and Drug Administration (FDA) and the European Medicine Agency have approved several inhaled antibiotics for cystic fibrosis treatment. However, none have been approved for VAP use, even with supporting evidence. Therefore, this study aimed to evaluate the effect of inhaled antibiotics as adjuvant therapy with IV or substitute in the treatment of VAP. The effect was measured based on clinical cure, microbial cure, and mortality. This study is a literature review and meta-analysis using a randomized control trial (RCT) design. The parameters measured were a clinical cure, microbial cure, and mortality. Furthermore, the literature search was conducted using the PubMed database. The included articles’ quality was assessed using the Critical Appraisal Skill Program (CASP) checklist and the journal’s reputation. Furthermore, 7 studies were included in the final review and meta-analysis. The results showed that the meta-analysis of inhaled antibiotics as adjuvant or substitution therapy is negative on clinical cure rates (RR=1,07; 95% CI=0,86–1,32) and mortality (RR=1,09; 95% CI=0,83–1,43). The analysis of inhaled antibiotics as adjuvant therapy was positive in microbiological cure (RR=1,56; 95% CI=1,13–2,17) but has no benefit as substitution therapy (RR=1,21; 95% CI=0,86–1,71). It can be concluded that using inhaled antibiotics as adjuvant therapy or monotherapy is ineffective in improving the clinical cure rate and mortality of VAP patients while using it as an adjuvant alone can eradicate microbes better.