Inhaled Antibiotics to Treat Ventilator-Associated Pneumonia: A Systematic Review and Meta-Analysis
Authors' conclusion
Compared with placebo/blank, adjunctive inhaled antibiotics improve clinical cure and microbiological eradication, and may reduce mortality, particularly in VAP-only patients.
Study context
- Population
- Patients with ventilator-associated pneumonia (VAP)32 randomized controlled trials (RCTs)
- Comparison
- Adjunctive inhaled antibiotics vs placebo/blank or IV antibiotics
- Outcome
- Clinical cure and all-cause mortality vs placebo/blank
Methodological detailsrandom effects models, subgroup analyses, meta-regression, trial sequential analysis, GRADE
- Random effects models
- Subgroup analyses
- Meta-regression
- Trial sequential analysis
- GRADE
Pooled result
As reported in the abstract
Inhaled antibiotics vs Placebo/blankRelative risk (95% CI)
Clinical cure; 16 RCTs; n = 1425
1.24(1.07–1.43)
All-cause mortality; 21 RCTs; n = 1855
0.84(0.71–0.98)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Clinical cure and all-cause mortality, VAP-only patients (subgroup)Inhaled antibiotics vs Placebo/blank · clinical cure; 11 RCTs; n = 775 | 1.29 (1.10–1.52) | |
| Clinical cure and all-cause mortality, VAP-only patients (subgroup)Inhaled antibiotics vs Placebo/blank · all-cause mortality; 15 RCTs; n = 1152 | 0.77 (0.65–0.90) | |
| Microbiological eradicationInhaled antibiotics vs Placebo/blank · 20 RCTs; n = 1805 | 1.42 (1.27–1.58) | |
| Emergence of new drug resistanceInhaled antibiotics vs Placebo/blank · 4 RCTs; n = 182 | 0.20 (0.06–0.64) | |
| 0.050.21520Relative risk (log scale) |
| Outcome | MD (d) (95% CI) | |
|---|---|---|
| Ventilator duration vs IV antibiotics3 RCTs; n = 322 | −2.11 (−3.73 to −0.49) | |
| −4−202Difference, d (linear scale) |
Clinical cure and all-cause mortality, VAP-only patients (subgroup)
- Not significant in studies including mixed pneumonia populations; meta-regression confirmed VAP-only population as a significant effect modifier
ICU LOS and ventilator duration vs placebo/blank
- No differences
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Nephrotoxicity vs IV antibiotics3 RCTs; n = 292 | 0.42 (0.26–0.68) | |
| 0.20.5125Relative risk (log scale) |
Other adverse events vs placebo/blank
- No differences
Original publication
Inhaled Antibiotics to Treat Ventilator-Associated Pneumonia: A Systematic Review and Meta-Analysis. Crit Care Med. Published 16 March 2026. doi:10.
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