Distinction must be made between tracheal inflammation and pneumonia

EDITOR—It is ironic that D'Amico et al's meta-analysis of trials of antibiotic prophylaxis for respiratory infection1 appears in the same issue as the House of Lords' report on resistance to antibiotic drugs.2 D'Amico et al did not restrict diagnostic criteria and did not distinguish between tracheobronchitis and pneumonia in their analysis. Although this distinction can be difficult, it is worth recognising that colonisation of the trachea and tracheobronchitis are common but trivial events in intubated patients and are probably inevitable. Whether their prevention is worth while is doubtful.

It would be interesting to know the comparative prevalence of tracheobronchitis in the 16% of treated and 36% of control patients who had “respiratory infection” in the trials that D'Amico et al studied. Inappropriate prophylaxis contributes to the overuse of antibiotics. We should remain cautious about topical and systemic prophylaxis for respiratory infection in critically ill patients and continue to try to separate true lung infection from tracheal inflammation.

Selective decontamination offers no advantage

EDITOR—Our first comment on the study by D'Amico et al concerns the search through Medline.1 They have excluded a study by Godard et al, who conducted a double blind placebo controlled …