Effectiveness and safety of adjunctive inhaled antibiotics for ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials

•The use of nebulized antibiotics is not supported by the currently available evidence as a routine therapeutic strategy for VAP.•The rates of clinical cure and microbiological eradication were improved by the use of aerosolized antibiotics in VAP patients; however, mortality was not reduced.•The administration of adjunctive antibiotics, such as aminoglycosides, through the respiratory tract was not associated with a higher risk of renal impairment, but the risk of bronchospasm was increased.