An Argument for the Use of Aminoglycosides in the Empiric Treatment of Ventilator-Associated Pneumonia

Abstract

Background: Appropriate empiric antibiotic therapy for ventilator-associated pneumonia improves outcomes. Controversy exists regarding the inclusion of aminoglycosides in empiric therapeutic regimens.

Methods: The Ovid and Cochrane databases were searched for relevant literature regarding the use of aminoglycosides in combination therapy for ventilator-associated pneumonia. The data supporting the use of aminoglycosides in certain populations and strategies to limit toxicity are summarized.

Results: In patients at high risk of infection with antibiotic-resistant gram-negative bacilli and in those with severe illness, aminoglycosides improve clinical outcomes. In critically ill populations, short-duration therapy and high-dose extended-interval dosing of aminoglycosides can improve therapeutic efficacy while limiting nephrotoxicity.

Conclusions: In selected populations using appropriate dosing strategies, aminoglycosides should be considered for empiric treatment of ventilator-associated pneumonia.

FIG. 1.

Percentage of gram-negative pathogens that were either pansensitive or multi-drug resistant by quarter after initiation of an antibiotic stewardship program in 2001. Trend lines demonstrate significant increase in percentage of pathogens that were pansensitive and decrease in those that were multi-drug resistant in both the trauma (TICU) and the surgical (SICU) intensive care units. (Reprinted with permission from Dortch et al. [28]).