Topical antibiotics used to prevent pneumonia in intensive care “hazardous and unsafe”

The use of topical antibiotics in clinical trials to prevent pneumonia in patients in intensive care units increased rather than decreased rates of pneumonia, a new analysis by the University of Melbourne has found.

The finding contradicts previous published research that topical antibiotics – medication applied to the patient’s airway– would decrease pneumonia rates.

Ventilator-associated pneumonia develops in approximately 20% of patients in intensive care units (ICUs) who are receiving prolonged medical ventilation.

However, in the control groups of these published clinical trials of topical antibiotics in this patient group, the pneumonia rates were as high as 40%.

Associate Professor James Hurley from the University of Melbourne’s Rural Health Academic Centre in Ballarat, analysed 206 international publications evaluating pneumonia prevention methods in ICU’s from the last 30 years.

Associate Professor Hurley conducted the analysis over ten years and said the surprising finding would help improve our understanding of how to evaluate pneumonia prevention methods in ICU.

His analysis found that the use of topical antibiotics increased the pneumonia risk in ICU patients by disrupting the balance of bacteria, not only in patients that received these antibiotics but also in control group patients co-located in the ICU.

“This changed flora is spread around the ICU environment to other patients through cross-infection,” Associate Professor Hurley said.

“This surprising finding is not apparent in any one study examined in isolation – it requires a meta-analysis of the control group pneumonia rates in all 206 studies to demonstrate these findings,” he explained.

“Pneumonia is commonly acquired by ICU patients, leads to longer stays in intensive care and can also increase mortality risk.”

“Therefore it appears topical antibiotics used in an effort to prevent pneumonia in the ICU are a hazard and the method is unsafe,” he said.

(Source: The University of Melbournee)