The largest study to date of SDD was conducted
in 13 ICUs in the Netherlands and showed a 28-day
mortality reduction with the use of SDD and SOD of
3.5 and 2.9 per cent, respectively43. In this trial, SDD
consisted of four days of intravenous cefotaxime
and topical application of tobramycin, colistin and
amphotericin B in the oropharynx and stomach. SOD
consisted of oropharyngeal application only of the
same antibiotics.While rigorous, a significant limitation
to this study was that it did not address the impact of
antibiotic resistance. A follow up study was, therefore,
conducted and showed that bacterial resistance in fact
increased in the ICUs that used SDD/SOD44. At this
time, despite repeated and rigorous studies, SDD/SOD
cannot be recommended for the prevention of VAP
due to concern for emergence of antibiotic-resistant
pathogens.