Comparative Efficacy Of Metoclopramide And Azithromycin In The Prevention Of Ventilator-Associated Pneumonia (VAP)

Abstract

Introduction and Background: Ventilator-associated pneumonia (VAP) poses a significant threat to critically ill patients in intensive care units (ICUs), contributing to increased morbidity, mortality, and healthcare costs. This study aims to compare the efficacy of two pharmacological interventions, metoclopramide, a prokinetic agent, and azithromycin, an antibiotic with anti-inflammatory properties, in preventing VAP in mechanically ventilated patients.

Objectives:  The primary objective is to compare the incidence of VAP between patients receiving metoclopramide and those receiving azithromycin. Secondary objectives include evaluating safety profiles, assessing impact on gastric residual volumes and inflammation markers.

Study Design: A randomized, controlled, open-label trial conducted from June 2021 to December 2022 in the ICU of Chirayu Medical College & Hospital.

Participants: Adults (≥18 years) on mechanical ventilation for ≥48 hours were included, excluding those with allergies to study drugs, significant gastrointestinal motility disorders, or severe liver/kidney dysfunction.

Interventions: Patients received either intravenous metoclopramide (Group A) or azithromycin (Group B) for up to 14 days.

Outcome Measures:   Primary outcome was the incidence of VAP within 14 days. Secondary outcomes included time to onset of VAP, gastric residual volumes, adverse events, length of ICU stay, and 28-day mortality.

Results:  The study found no significant difference in VAP incidence between the two groups. Both drugs showed similar safety profiles and secondary outcomes.

Discussion: Lower-than-expected VAP rates may have impacted statistical power. Nonetheless, both interventions demonstrated comparable efficacy and safety, suggesting their potential utility in VAP prevention.

Conclusion: Both metoclopramide and azithromycin appear equally effective in preventing VAP in mechanically ventilated patients. Further research could explore combined drug regimens or alternative strategies for VAP prevention.

Potential Impact: Identifying effective pharmacological interventions for VAP prevention could improve patient outcomes and reduce healthcare-associated infections in ICUs, thus benefiting both patients and healthcare systems. Further research is warranted to confirm and extend these findings.