The use of antibiotic therapy for VAT has been evaluated in two recently conducted, randomized trials. The first trial, by Palmer et al,3 was a double-blind, randomized, placebo-controlled study of medical and surgical ICU patients who received either targeted aerosolized antibiotic(s) treatment for 14 days or until extubation (n = 19) vs a saline solution placebo (n = 24). VAT was defined as the production ≥ 2 mL of purulent endotracheal secretions over a 4-h period with a Gram stain demonstrating bacteria. Aerosolized antibiotics included gentamicin sulfate if Gram-negative bacilli were present, vancomycin for Gram-positive bacteria, and both for those with mixed infections. Systemic antibiotics were administered at the discretion of treating physician, and were frequently prescribed in both groups. The aerosolized antibiotic group had significantly lower rates of clinical signs and symptoms of VAP, better weaning, reduced numbers of antibiotic-resistant organisms, and lower use of systemic antibiotics when compared to the placebo group (all end points, p < 0.05).3 Notable limitations of this study included the concerns over the a definition of VAT without quantitative microbiologic evaluation of ETAs, high numbers of patients who had prior VAP, lack of data on radiographic signs of VAP, small numbers of patients studied, potential confounding by the use of systemic antibiotics, and possible risk of complications with the widespread or long-term use of aerosolized antibiotic therapy for 14 days.