Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial -

Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial
Information type: Randomised controlled trials
Source: The Lancet Infectious Diseases
Specialities: Infection and infectious diseases | Respiratory disorders
Summary
RCT (n=725) found no between-group difference in survival: 191 (75%) patients in Amikacin Inhale group vs. 196 (77%) patients in placebo group survived until days 28–32 (OR 0.841, 95% CI 0.554–1.277; p=0.43) and authors do not support use of inhaled amikacin in this setting.
UKMi comment
Authors of a related commentary however, state results of this trial should not dissuade investigators from studying adjunctive inhaled antibiotics for ventilated patients; as certain features of the trial could have negated the treatment benefit in the intervention group vs. control group and might explain why the trial found no benefit of inhaled antibiotics. For example, heterogeneity in patient care between groups and use of the vibrating mesh nebuliser, which is infrequently used in practice compared with jet nebulisation.
Related links: Commentary