JAC Advance Access originally published online on October 13, 2007
Journal of Antimicrobial Chemotherapy 2007 60(6):1216-1226; doi:10.1093/jac/dkm385
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Systematic review |
Administration of antimicrobials via the respiratory tract for the treatment of patients with nosocomial pneumonia: a meta-analysis
1 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece 2 Department of Medicine, Henry Dunant Hospital, Athens, Greece 3 Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
Received 2 August 2007; returned 26 August 2007; revised 12 September 2007; accepted 13 September 2007
* Correspondence address. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece. Tel: +30-694-611-0000; Fax: +30-210-683-9605; E-mail: m.falagas{at}aibs.gr
Background: Aerosolized antibiotics are a widely recognized treatment for patients with cystic fibrosis (CF). We sought to clarify their role in the treatment of non-CF patients with nosocomial pneumonia by performing a meta-analysis of randomized controlled trials (RCTs) that compared administration of antimicrobials via the respiratory tract (with or without concurrent usage of systemic antibiotics) with control treatment.
Methods: An extensive search of PubMed, Scopus, Cochrane Central Register of Controlled Trials, Current Contents and bibliographies from retrieved publications was made.
Results: Five RCTs were included in the meta-analysis. Administration of antimicrobials via respiratory tract (either inhaled or endotracheally instilled) as opposed to control was associated with better treatment success in intention-to-treat [fixed effect model: odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.29–4.44; random effects model: OR = 2.75, 95% CI 1.06–7.17] and in clinically evaluable patients (fixed effect model: OR = 3.14, 95% CI 1.48–6.70; random effects model: OR = 3.07, 95% CI 1.15–8.19). There were no statistically significant differences between therapeutic regimens regarding all-cause mortality (fixed effect model: OR = 0.84, 95% CI 0.43–1.64; random effects model: OR = 0.71, 95% CI 0.27–1.88), microbiological success (fixed effect model: OR = 2.06, 95% CI 0.91–4.68; random effects model: OR = 2.23, 95% CI 0.64–7.71) and toxicity (fixed effect model: OR = 0.34, 95% CI 0.04–2.53; random effects model: OR = 0.36, 95% CI 0.04–3.16).
Conclusions: The limited available evidence seems not to preclude a benefit from the administration of antimicrobial agents via the respiratory tract for treating nosocomial pneumonia.
Keywords: ICU-acquired pneumonia , healthcare-associated pneumonia , ventilator-associated pneumonia , respiratory tract infections
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