Use of Gentamicin as Empiric Coverage for Ventilator-Associated Pneumonia: The "Con" Perspective.

BACKGROUND: Gentamicin is used commonly as an empiric antibiotic prior to culture evidence in the treatment of ventilator-associated pneumonia (VAP) in surgical patients.

METHODS: The published literature on the use of gentamicin for empiric therapy in VAP was reviewed and in combination with the author's personal experience, an evaluation has been made about the indications for the use of this antibiotic in VAP.

RESULTS: Empiric gentamicin use appears to benefit less than 1% of patients in the treatment of presumptive VAP. The problematic pharmacokinetics of gentamicin use in this patient population combined with potential toxicity from the drug can be observed to yield greater risks than benefits in this clinical situation when published evidence is reviewed.

CONCLUSION: There is no definitive evidence to support empiric use of gentamicin in the treatment of VAP when evaluated on a cost-effective basis.