Clinical Outcomes of Inhaled Amikacin in Ventilator-Associated Pneumonia: A group randomized controlled, add-on trial

Background: Many clinical trials support the role of inhaled amikacin when combined with IV antibiotics in eradication of bacterial infections, reduce mortality and improve cure in ICU patients. Local contextual data is limited, leaving research gap. Objective: To assess the effect of inhaled amikacin as an add-on adjunct to the intravenous antibiotics in ventilator- associated pneumonia ICU patients on clinical outcomes. Methodology: This group randomized controlled add-on trial was conducted to assess the clinical outcomes of inhaled amikacin in VAP treatment. 180 ventilated patients with VAP were recruited from the two Intensive Care Units of Lahore General Hospital Surgical between January to December 2024. Patients were divided into two groups: one received empirical intravenous antibiotics (group N), and the other was administered inhaled amikacin along with empirical intravenous antibiotics (group A). Clinical variables including the duration of mechanical ventilation, length of stay in the ICU and symptom resolution, were compared between the two groups using t-tests and chi-square tests. Results: Group A had a statistically significant shorter mean duration of mechanical ventilation than patients in Group N (6.8 days vs. 9.36 days, p<0.05). However, there was no significant difference in the mean duration of ICU stay between the two groups (13.9 days vs. 14.3 days, p=0.290). Group A had a higher percentage of symptom resolution compared to Group N (88% vs. 57%, p<0.0001), with an odds ratio of 4.31 (95% CI: 2.13-8.72, p<0.00I) indicating significantly higher odds of symptom resolution with inhaled amikacin. Conclusion: By using inhaled amikacin as an additional treatment for ventilator-associated pneumonia clinical outcome was improved and the duration of mechanical ventilation was reduced. Ventilator-associated pneumonia (VAP) is a hospital- acquired infection that is linked to high morbidity, mortality, and healthcare expenses. Inhaled amikacin may serve as an adjunctive therapy for VAP, offering targeted delivery and reducing systemic toxicity.