Assessment of aerosolized Colistin and Gentamicin in mechanically ventilated patient

Abstract

Abstract Background and Objectives ineffective parental antibiotic use in treatment of Ventilator associated pneumonia (VAP) open the window for using inhaled antibiotic formula to achieve higher local concentration of antibiotics and subsequently good recovery response, the aim of that work was evaluation of aerosolized antibiotics (Colistin and Gentamicin) efficacy in improving the mechanically ventilated patient as adjunctive to intravenous systemic antibiotics Methods 30 mechanically ventilated patients classified equally in to 3 groups; Group I 10 patients received aerosolized Colistin along with systematic antibiotics (SA). Group II: 10 patients received aerosolized Gentamicin along with systematic antibiotics (SA) and Group III (Control): 10 patients received only systematic antibiotics (SA). All patients were followed up for clinical response by bacteriological culture (after 5 days of aerosolized antibiotics), development of VAP, days of mechanical ventilation, length of stay in the ICU, and mortality. Results The incidence of VAP was 10%; in group I no cases had VAP, while in group II and control group, just (20%) and (10%) of cases had VAP respectively, with insignificant association of VAP with particular group, (P = 0.3). Clinically; only group I showed significant lower degree of temperature in comparison with control group, (P = 0.01). The mean days of MV and ICU in each groups were (6.8±2.15; 8.9±3.11, 5.9±2.23; 7.2±2.7, 5.1±1.1; 6.1±1.85) respectively, with insignificant statistical difference between the treatment groups, (P = 0.2 and 0.07) respectively. Finally, the survival rate in group I was 90%, and was slightly lower in group II and control group; 60% and 50% respectively, with insignificant association of survival status in particular group, (P = 0.1) Conclusion the empirical treatment by AA (Colistin) was effective as an adjuvant to systemic antibiotics for protection of VAP than aerosolized Gentamicin, it had rapid resolution of respiratory infection signs, and subsequently the mechanical ventilation days, ICU stay days, and probably the cost of ICU admission, but did not affect mortality.