From the Research
For a pulmonary abscess in an infant caused by Methicillin-Sensitive Staphylococcus aureus (MSSA), nebulized vancomycin is the most appropriate inhaled antibiotic option, as it achieves high local concentrations in the lungs while minimizing systemic exposure and toxicity. The recommended dosage is typically 4 mg/kg per dose administered via nebulizer twice daily, with treatment duration of 7-14 days depending on clinical response 1. This should be used as adjunctive therapy alongside systemic antibiotics, not as monotherapy. Nebulized vancomycin is effective against MSSA by inhibiting cell wall synthesis, and delivering it directly to the site of infection can help improve outcomes when combined with systemic therapy.
Some key considerations for the use of nebulized vancomycin include:
- Preparation of the medication using preservative-free sterile water or normal saline
- Administration through an appropriate pediatric nebulizer system
- Close monitoring for bronchospasm during administration
- Pre-treatment with a bronchodilator may be beneficial Alternative inhaled options might include tobramycin, but vancomycin is generally preferred for confirmed MSSA infections due to its excellent gram-positive coverage 2. It's also important to note that the treatment of pulmonary abscesses may require a combination of antibiotic therapy and other interventions, such as percutaneous transthoracic tube drainage (PTTD) or endoscopic catheter drainage (ECD), in cases where the abscess does not respond to antibiotics alone 3. However, the use of nebulized vancomycin as an adjunctive therapy can help improve outcomes and reduce the need for more invasive procedures.
In terms of the evidence, while there are various studies on the treatment of pulmonary abscesses and MSSA infections, the most recent and relevant study 1 supports the use of nebulized vancomycin as an effective treatment option for pulmonary abscesses in infants caused by MSSA. Other studies, such as 4 and 5, provide additional context and information on the treatment of pulmonary abscesses and MSSA infections, but are not as directly relevant to the specific question of inhaled antibiotic treatment for pulmonary abscesses in infants caused by MSSA.