Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia

To the Editor: Ehrmann et al. (Nov. 30 issue)(1) found, in the Inhaled Amikacin vs. Placebo to Prevent Ventilator Associated Pneumonia (AMIKINHAL) trial, that among adults who had undergone mechanical ventilation for at least 3 days, a subsequent 3-day course of inhaled amikacin reduced the incidence of ventilator-associated pneumonia. The use of a low suspicion threshold for reporting possible cases of ventilator-associated pneumonia resulted in a higher incidence of disease in the control group (22%) than anticipated in the sample-size calculation (12%) and may have identified cases that were not clinically consequential. In addition, there are limitations to using bacterial . . .