Aerosolized antibiotics: current and future.

Aerosolized antibiotic therapy appears to have potential for targeted therapy to the airways and deep lung to prevent VAP in patients at high risk for this disease. The definition of that high-risk population is important if this model is to be successful. We are attempting to define susceptible patients by measuring the volume of airway secretions, which mirrors the inflammation milieu of the central airways. Elevated sputum volume is marked by heavy growth of pathogenic organisms and high levels of inflammatory cytokines. Large-scale clinical trials are necessary to define the usefulness of these surrogates in defining a targeted population and for assessing the potential of aerosolized antibiotic prophylactic therapy for preventing pneumonia and mortality. If successful, the aerosol approach may avoid systemic therapy and its associated complications.