A Comprehensive Review of Nebulized Antibiotics in Lower Respiratory Tract Infections: Insights from the 2024 IDSA Guidelines

Background:The increasing prevalence of antibiotic resistance and the complexity of treating lower respiratory tract infections (LRTIs) in critically ill patients have brought nebulized antibiotics into focus as a promising therapeutic option.This review explores the current evidence on the efficacy, limitations, and safety of nebulized antibiotics for LRTIs, particularly those caused by gram-negative and multidrug-resistant pathogens.Methods: A comprehensive literature search was performed using a systematic approach across databases such as PubMed, Cochrane Library, and Scopus, focusing on studies concerning nebulized antibiotics in adults with LRTIs.The key inclusion criteria emphasized research on the efficacy, safety, and pharmacokinetics of nebulized antibiotics. Results:The analysis of randomized controlled trials and meta-analyses indicated that nebulized antibiotics can achieve high concentrations at the site of infection, which may improve clinical outcomes.However, despite favorable pharmacokinetics, clinical trials have demonstrated limited improvements in mortality and overall efficacy compared with traditional intravenous therapies.This review also discussed safety considerations related to nebulized antibiotics, including potential adverse effects and delivery challenges.Current clinical guidelines, including those from the IDSA 2024, recommend cautious use of nebulized antibiotics for LRTIs, particularly for ventilator-associated pneumonia.Significant knowledge gaps in optimal dosing, delivery methods, and patient selection criteria are identified in this review.Moreover, the need for further research to establish clear clinical guidelines that could improve the application of nebulized antibiotics is emphasized. Conclusion:Although nebulized antibiotics have potential benefits for managing LRTIs, additional studies are required to optimize their efficacy and safety within clinical settings.