Combination Therapy for Carbapenem-resistant Gram-negative Bacteria

Alexandre P Zavascki; Jurgen B Bulitta; Cornelia B Landersdorfer


Expert Rev Anti Infect Ther. 2013;11(12):1333-1353. 

In This Article

Alternative Adjuvant Therapies

Inhalatory Therapy

Although therapy with inhaled antibiotics is not being considered as a part of combination schemes, it has been used as an adjuvant to systemic therapy in ventilator-associated pneumonia caused by CR GNB. The main drug used is CMS and the rationale is reaching higher drug concentrations at the site of the infection while avoiding or minimizing systemic toxicity. Although many case series have reported good response rates with inhalatory therapy, most have lacked a control group.[210–212]

In the few comparative studies, including two RCTs, no benefit in mortality was found with adjuvant inhalatory therapy.[213–215] Nonetheless, most, but not all studies,[213–215] have found higher rates of microbiological eradication with inhalatory therapy. Considering the current clinical evidence, inhalatory therapy cannot be routinely recommended in the treatment of ventilator-associated pneumonia caused by CR GNB. However, it might be considered in cases where systemic polymyxins are not tolerated and/or when microbiological eradication is an objective of the therapy. Indeed, it might have implications in the control of dissemination of these organisms, but it still requires further investigations. In the authors' opinion inhalatory therapy cannot substitute an adjuvant parenteral drug in combination schemes.