OBJECTIVE： To observe the efficacy and safety of amikacin different administrations in the treatment of ventilator-associated pneumonia. METHODS： Data of 109 patients with ventilator-associated pneumonia were divided into observation group （58 cases） and control group （51 cases） based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection， adding into 100 ml 0.9％ Sodium chloride injection， intravenously， once every 12 h. Based on it， control group received 7.5 mg/kg Amikacin sulfate injection， once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection， adding into 20 ml 0.45％ Sodium chloride injection， aerosol inhalation， twice a day. The treatment course for both groups was 7 d. Clinical pulmonary infection score （CPIS）， alanine aminotransferase （ALT）， serum creatinine （Cr）， oxygenation index （PaO2/FiO2）， IL-10， IL-6， C-reactive protein （CRP）， tumor necrosis factor （TNF） -α， cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS： Before treatment， there were no significant differences in the CPIS score， ALT， Cr， PaO2/FiO2， IL-10， IL-6， CRP and TNF-α levels in 2 groups （P＞0.05）. After treatment， CPIS score， TNF-α， IL-6 and CRP levels in 2 groups were significantly lower than before， observation group was lower than control group， the difference was statistically significant （P＜0.05）， and there was no significant difference in IL-10 before and after treatment in 2 groups （P＞0.05）. PaO2/FiO2 in observation group and ALT， Cr and PaO2/FiO2 in control group were significantly higher than before， PaO2/FiO2 in observation group was higher than control group， ALT and Cr were significantly lower than control group， the differences were statistically significant （P＜0.05）. The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group， the difference was statistically significant （P＜0.05）. And there were no severe adverse reactions during treatment. CONCLUSIONS： The efficacy of amikacin by aerosol inhalation is superior to by intravenous infusion in the treatment of ventilator-associated pneumonia， it can effectively reduce inflammatory cytokine levels and mortality rate， do not increase the incidence of adverse reactions.