Effect of prophylactic nebulization of Colistin versus Amikacin on the incidence of ventilator-associated pneumonia in an intensive care unit setting with prevalent multidrug-resistant bacteria: A prospective double-blind randomized placebo-controlled trial.

To study the effect of prophylactic nebulization of antibiotics on  VAP reduction in an ICU with multidrug resistant bacteria, patients >18 years and requiring mechanical ventilation duration for >72 hours (total 156 patients), will receive either  nebulization with colistin (colistimethate sodium, 1.5M IU, diluted in water for injection) or with amikacin (amikacin at a dose of 20 mg per kilogram of ideal body weight) or with an equivalent volume of 0.9% normal saline once a day for 3 days prepared by an investigator in a 5 mL syringe labeled as ‘study drug’. Disposable vibrating mesh nebulizer will be placed in the inspiratory limb of the ventilatory circuit.  Complications if any will be noted. Data will be compiled and appropriate statistical test will be applied to analyse the result. The study results may be used to provide recommendation regarding the use of prophylactic antibiotics for VAP prevention particularly in the setting with prevalent multi-drug resistant bacteria.