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A Randomized, Placebo-Controlled, Double-blind Clinical Trial

Jérôme Pugin, MD; Raymond Auckenthaler, MD; Daniel P. Lew, MD; Peter M. Suter, MD

JAMA. 1991;265(20):2704-2710.

Abstract
Secondary pneumonia in patients requiring mechanical ventilation has a high morbidity and mortality. Diagnosis is difficult and treatment failure common; therefore, preventive measures are important. In a double-blind, placebo-controlled trial, we evaluated selective decontamination of the oropharynx with polymyxin B sulfate, neomycin sulfate, and vancomycin hydrochloride (PNV) in 52 patients requiring mechanical ventilation during a 3- to 34-day period (mean, 10 days). Either PNV or placebo was administered six times daily in the oropharynx. During the first 12 days of intubation, tracheobronchial colonization by gramnegative bacteria and Staphylococcus aureus, as well as pneumonia, occurred less frequently in the PNV than in the placebo group (16% vs 78%; P<.0001). Hospital mortality was not different, but systemic antibiotics were prescribed less often in the PNV group and no resistant microorganism emerged. In these critically ill patients, topical oropharyngeal antibiotic application lowered the rate of ventilator-associated pneumonia by a factor of 5, probably by interrupting the stomach-to-trachea route of infection, and decreased the requirement for intravenous antibiotics.

(JAMA. 1991;265:2704-2710)

Author Affiliations
From the Division of Surgical Intensive Care, Department of Anesthesiology (Drs Pugin and Suter), and the Division of Infectious Diseases, Department of Medicine (Drs Auckenthaler and Lew), University Hospital of Geneva (Switzerland).

Footnotes
Reprint requests to Division of Surgical Intensive Care, University Hospital of Geneva, CH-1211 Geneva 4, Switzerland (Dr Suter).

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