A review of the therapeutic efficacy of aerosolized and endotracheally instilled antibiotics.

Achievement of sufficient concentrations of aerosolized antibiotic at the site of infection is limited by technical problems in antibiotic delivery and by drug inactivation. Antibiotic delivery by aerosolization is generally associated with minimal systemic absorption, whereas systemic absorption may be significant after endotracheal instillation. Methodologic problems make correlations between clinical response and sputum antibiotic concentrations difficult. Studies suggest that aerosolized antibiotics are of little value in the treatment of chronic bronchopulmonary infections. Endotracheal instillation appears to be associated with favorable clinical responses, possibly due to enhanced antibiotic delivery to the site of infection. Prophylactic aerosolized antibiotics are effective in altering sputum flora; reduction in mortality from acquired pneumonia has not been demonstrated. The development of resistant organisms may occur as a result of prophylactic treatment.