Abstract
<h3>To the Editor.</h3> —Pugin et al<sup>1</sup>reported that topical oropharyngeal decontamination with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride in patients requiring mechanical ventilation can greatly reduce the incidence of tracheobronchial colonization and pneumonia compared with a placebo administered in the same fashion. This is the latest in a series of studies that have demonstrated uniformly that the frequency of pneumonias acquired in the intensive care unit can be reduced by oropharyngeal, gastric, and occasionally, systemic antibiotics. This study has also added further confirmation to a growing body of evidence that while many critically ill patients die<i>with</i>pneumonia, they do not necessarily die<i>from</i>pneumonia. Despite a fivefold reduction in the risk of pneumonia in patients receiving oropharyngeal antibiotics, Pugin et al found no difference in the hospital mortality between patients who received oropharyngeal antibiotics and those who received oropharyngeal placebos. Similar data, with different antibiotic regimens,
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