Bronchoscopic instillation of amikacin in patients with ventilator-associated pneumonia

Abstract

Introduction In the era of the emergence of multidrug resistant organisms, it appears that bacteria are beating the battle against the poor development of new effective antibiotics. Aminoglycosides are effective against many Gram-negative bacteria especially when given in large doses, but unfortunately it may be potentially toxic; therefore, there was an inclination toward administration of these antibiotics directly to the airway to get a high concentration of the drug at the site of infection with minimal systemic adverse effects. Patients and methods A total of 130 patients with ventilator-associated pneumonia were randomized to amikacin instillation (amikacin-instillation group) (AIG) and intravenous control group (ICG). Bronchial amikacin and serum trough amikacin levels were measured. Enrolled patients were followed up, and clinical cure, microbiological cure, mortality, and length of stay in the ICU stay were monitored. Results In AIG, bronchial level of amikacin reached a concentration of 18 700 mcg/l (mean=13 156 mcg/l), associated with nonsignificant increase in the trough levels of amikacin. There was a significant expedition of the clearance of infection and decrease in the ventilator-free days in the AIG. However, there were no significant differences between the two groups regarding mortality and ICU stay. Conclusion Bronchoscopic instillation of amikacin is a feasible, effective, and safe mode of direct antibiotic delivery in patients with ventilator-associated pneumonia.