25 Apr 06
Ventilator-associated pneumonia: monotherapy is optimal if chosen wisely
By BA Cunha
Critical Care 2006;10:141
Traditionally, ventilator-associated pneumonia (VAP) has been treated either with double drug therapy or with monotherapy. Double drug therapy has been used to increase spectrum, for possible synergy, and to decrease the emergence of resistance. VAP therapy should be directed primarily against Pseudomonas aeruginosa, which also provides aerobic gram-negative coverage, the usual pathogens in VAP. The potent anti-P. aeruginosa antibiotics available today have sufficient activity that double drug coverage is unnecessary. Double drug therapy does not decrease resistance if a “high resistance potential” antibiotic is used in the combination. The study by Damas in this issue supports monotherapy for VAP. Optimal therapy for VAP selecting a potent anti-P. aeruginosa antibiotic with a “low resistance potential”, minimizes drug/drug interactions, minimizes resistance potential, and is cost effective. Monotherapy of VAP should be the standard of care.