Inhaled Antibiotics as Adjunct Therapy Should Be Evaluated in Conjunction with Systemic Antibiotic Treatments
By
Patrick M. Honoré
Yasser Benkaddour
Catherine Yildiz Muscato
August 17, 2026
Clinical Scorecard: Inhaled Antibiotics as Adjunct Therapy Should Be Evaluated in Conjunction with Systemic Antibiotic Treatments
At a Glance
Category Detail
Condition Ventilator-Associated Pneumonia (VAP) Key Mechanisms Adjunctive inhaled antibiotics may lead to systemic absorption, affecting nephrotoxicity risk. Target Population Critically ill patients with VAP, particularly those infected with multidrug-resistant pathogens. Care Setting Critical care and intensive care units
Key Highlights
Nebulized colistin shows lower nephrotoxicity compared to IV colistin. Systemic absorption of nebulized colistin can occur, leading to potential acute kidney injury. Pharmacokinetic studies indicate significant plasma colistin concentrations from nebulized administration. Caution is advised when using nebulized colistin alongside systemic colistin therapies. Guideline-Based Recommendations
Diagnosis
Consider the specific pathogen and systemic antibiotic regimen when diagnosing VAP. Management
Evaluate the use of adjunctive inhaled antibiotics in conjunction with systemic treatments. Monitoring & Follow-up
Monitor for nephrotoxicity in patients receiving both nebulized and IV colistin. Risks
Increased risk of nephrotoxicity with cumulative systemic exposure from nebulized and IV colistin. Patient & Prescribing Data
Critically ill surgical patients with VAP due to multidrug-resistant Acinetobacter baumannii.
Nebulized colistin should not be considered strictly local therapy due to systemic absorption.
Clinical Best Practices
Conduct further pharmacokinetic and clinical studies to optimize inhaled and systemic colistin therapy combinations. Assess individual patient risk factors for nephrotoxicity when prescribing colistin therapies. Related Resources & Content
