26 Oct 2023 • Among patients who had received invasive mechanical ventilation for at least 3 days, a subsequent 3-day course of preventive inhaled amikacin reduced the burden of VAP during 28 days of follow-up, as per recent research published in the New England Journal of Medicine.

Ventilator-associated pneumonia is a disease with an attributable mortality of up to 13% and contributes to increased systemic antibiotic consumption, duration of mechanical ventilation and ICU lengths of stay, and costs. Inhaled antibiotic therapy enables delivery of very high antibiotic concentrations to the tracheobronchial tree, lung parenchyma, and tracheal-tube biofilm.

In an investigator-led, multicenter study(AMIKINHAL trial), critically ill adults who had been on invasive mechanical ventilation for at least 72 hours were randomly assigned to receive inhaled amikacin at a daily dose of 20 mg per kilogram of their ideal body weight or a placebo for a duration of 3 days. The primary goal was to evaluate the impact on the occurrence of ventilator-associated pneumonia over a 28-day follow-up period.

KEY FINDINGS

• Out of the 850 patients included in the study, 417 received amikacin, and 430 received the placebo.
• Ultimately, the study found that ventilator-associated pneumonia occurred in 15% of the amikacin group and 22% of the placebo group after 28 days, indicating a statistically significant reduction in the risk of ventilator-associated pneumonia with inhaled amikacin.
• Moreover, there were fewer infection-related ventilator-associated complications and very few trial-related serious adverse effects associated with amikacin use.

Source: NEJM | Read full story