A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in m
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(2020) 12:47
ORIGINAL ARTICLE
Ain-Shams Journal of Anesthesiology
Open Access
A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in mechanically ventilated patients with ventilator-associated pneumonia (VAP) Dalia M. El Fawy, Azza Yousef Ibrahim, Ahmed Mostafa Mohamed Abdulmageed*
and Eman Abo Bakr El Seddek
Abstract Background: Aerosolized antibiotic administration offers the theoretical advantages of achieving high drug concentrations at the infection site together with lower systemic absorption. This study aims to compare the effect of combining nebulized amikacin with intravenous amikacin to the effect of the usual intravenous route alone in the treatment of patients with ventilator-associated pneumonia and its impact on the duration of mechanical ventilation, laboratory, and clinical picture of the patients. Results: This study was carried out on 64 mechanically ventilated patients with Gram-negative VAP. The patients were divided into 2 groups. Group A included 32 patients treated with nebulized amikacin plus IV amikacin, and group B included 32 patients treated with IV amikacin alone. The duration of treatment for both groups was 8 days with a daily assessment of Clinical Pulmonary Infection Score (CPIS) and monitoring of clinical and laboratory parameters. Sputum cultures were obtained thereafter. In our study, the CPIS score and overall ICU mortality were less in the nebulized than in the IV group but the difference failed to be statistically significant. Increase of oxygenation level (Pao2/Fio2 ratio), organism clearance, decrease in serum creatinine level, duration of mechanical ventilation, and length of ICU stay were significantly different in favor of group A than group B. Conclusion: Nebulized and IV amikacin offered better oxygenation, organism clearance, less nephrotoxicity, and less duration of mechanical ventilation and ICU stay than the IV group. Combined and IV routes were comparable regarding the decrease in CPIS score and ICU mortality with no significant difference between them. However, we prefer to use the combined regimen for the mentioned reasons. Further large-scale studies are required to confirm these findings and to establish a definite conclusion. Keywords: Amikacin, Nebulized, VAP, Ventilation, Intravenous, Antibiotics
* Correspondence: [email protected]; [email protected] Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Fifth settlement, Cairo 11865, Egypt © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons
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