Nebulizer mask floating above a heart, symbolizing pneumonia treatment after surgery.

Nebulized Amikacin: A Game-Changer for Pneumonia After Cardiac Surgery?

Avery Sinclair in Health & Wellness June 2025 • 4 min read.

"New research suggests nebulized antibiotics may offer a safer, more effective alternative to IV antibiotics for treating pneumonia following heart surgery."

Pneumonia is a significant concern for patients recovering from cardiothoracic surgery. These individuals often require mechanical ventilation, which unfortunately increases the risk of developing hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). When these infections are caused by multidrug-resistant (MDR) bacteria, treatment becomes even more challenging.

Traditional treatment approaches often involve intravenous (IV) antibiotics. However, a recent study has explored the potential of nebulized antibiotics as an adjunctive therapy. Nebulized antibiotics deliver medication directly to the lungs, potentially achieving higher concentrations at the site of infection while minimizing systemic side effects.

This article delves into a study comparing the efficacy and safety of nebulized versus IV amikacin, a powerful antibiotic, in post-cardiac surgery patients with pneumonia caused by MDR Gram-negative bacteria. We’ll explore the findings, implications, and what this could mean for future treatment strategies.

Nebulized vs. IV Amikacin: What the Study Revealed

Nebulizer mask floating above a heart, symbolizing pneumonia treatment after surgery.

A prospective, randomized, controlled study was conducted involving patients recovering from cardiothoracic surgery who developed HAP or VAP caused by MDR Gram-negative bacteria. The participants were divided into two groups: one receiving IV amikacin and the other receiving nebulized amikacin, both in addition to IV piperacillin/tazobactam. Researchers then compared several outcomes, including:

Here’s a breakdown of the key findings:

Clinical Cure Rates: Patients receiving nebulized amikacin showed significantly higher clinical cure rates compared to those receiving IV amikacin.
ICU Stay: The nebulized group experienced shorter stays in the intensive care unit.
Time to Clinical Cure: Nebulized amikacin led to a faster recovery, with patients reaching clinical cure in fewer days.
Ventilator Dependence: Patients in the nebulized group required fewer days on mechanical ventilation.
Nephrotoxicity: Nebulized amikacin was associated with less kidney damage, as indicated by preserved kidney function and lower rates of acute kidney injury (AKI).

These results suggest that nebulized amikacin offers several advantages over IV amikacin in this specific patient population. The direct delivery to the lungs likely contributes to better efficacy, while the reduced systemic absorption minimizes the risk of kidney damage.

The Future of Pneumonia Treatment After Surgery?

This study provides compelling evidence for the potential benefits of nebulized amikacin in treating pneumonia following cardiothoracic surgery. While further research is always warranted, these findings suggest a promising avenue for improving patient outcomes, reducing hospital stays, and minimizing the risk of antibiotic-related complications. As antibiotic resistance continues to rise, exploring alternative delivery methods like nebulization becomes increasingly important. Nebulized amikacin may offer a valuable tool in the fight against MDR infections, particularly in vulnerable patient populations.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/ccm.0000000000002695, Alternate LINK

Title: Nebulized Versus Iv Amikacin As Adjunctive Antibiotic For Hospital And Ventilator-Acquired Pneumonia Postcardiac Surgeries

Subject: Critical Care and Intensive Care Medicine

Journal: Critical Care Medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Nehal A. Hassan, Faten Farid Awdallah, Maggie M. Abbassi, Nirmeen A. Sabry

Published: 2018-01-01

Everything You Need To Know

Why is pneumonia a major problem after heart surgery?

Pneumonia after cardiothoracic surgery is a serious concern due to the increased risk associated with mechanical ventilation. This risk often leads to hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). These infections can be particularly challenging when caused by multidrug-resistant (MDR) bacteria, making effective treatment crucial for patient recovery and survival.

How does nebulized amikacin differ from IV antibiotics?

Nebulized amikacin offers a promising alternative to traditional intravenous (IV) antibiotics. It delivers medication directly to the lungs, where the infection is located, potentially achieving higher concentrations at the site of infection. This method may lead to better clinical outcomes and reduced systemic side effects compared to IV amikacin. A recent study demonstrated that the nebulized amikacin group had higher clinical cure rates and shorter ICU stays.

What did the study reveal about amikacin?

Amikacin is a potent antibiotic, and the study compared the efficacy and safety of nebulized versus intravenous amikacin in post-cardiac surgery patients with pneumonia caused by MDR Gram-negative bacteria. Researchers found that nebulized amikacin showed significantly higher clinical cure rates, shorter ICU stays, and a faster time to clinical cure. Additionally, the nebulized amikacin group experienced reduced kidney damage (nephrotoxicity) compared to the IV amikacin group.

What is nephrotoxicity and how does it relate to this study?

Nephrotoxicity, or kidney damage, is a significant concern with certain antibiotics, including amikacin. The study found that nebulized amikacin was associated with less kidney damage compared to IV amikacin. This is likely because nebulization delivers the drug directly to the lungs, minimizing systemic absorption and reducing the exposure of the kidneys to the antibiotic. Preserved kidney function and lower rates of acute kidney injury (AKI) in the nebulized amikacin group support this finding.

What are the potential implications of using nebulized amikacin in the future?

The implications of using nebulized amikacin are significant. The study suggests it improves patient outcomes by potentially reducing hospital stays and the risk of antibiotic-related complications. As antibiotic resistance rises, nebulized amikacin could become a valuable tool in fighting MDR infections, especially in vulnerable patients recovering from cardiothoracic surgery. Further research is warranted, but these findings offer a promising avenue for enhancing pneumonia treatment strategies in the future.