Development of ventilator- associated pneumonia [VAP] is associated with high morbidity and mortality rates. VAP mortality ranges between 5.8% and 27% [1]. Routine administration of intravenous antibiotics does not reach a bactericidal concentration in lung tissues. intravenous antibiotics are mainly detected in respiratory segments of lungs, but not in sputum. [2]. This study was conducted on 60 patients who were admitted to critical care department at Benha University Hospital and diagnosed with Ventilator Associated Pneumonia [VAP]. patients were divided into two groups: Group A included 30 patients have received only systemic antibiotics and Group B included 30 patients have received systemic and nebulized antibiotics. In this study the clearance of organism, resistance, superinfection and combined [resistance and super infection] were significantly different in group A vs. B . There was significant decrease regarding creatinine level in group B vs. A . There were significant reduction in duration of MV and length of ICU stay in group B vs. A. Nebulized Amikacin plus ceftazidime are effective in the treatment of VAP.