BACKGROUND: It is recommended to use aerosolized (AS) colistin in patients undergoing mechanical ventilation therapy as an adjunctive in the latest guidelines, in spite of high nephrotoxicity and limited studies. In this study, systematic reviews and metaanalyzes were conducted to evaluate the safety and efficacy of AS colistin in patients with ventilator-associated pneumonia. METHODS: Two authors independently searched related literature published from Pubmed and EMBASE until July 2016 and included a study comparing adjunctive AS colistin with intravenous (IV) colistin monotherapy. The primary outcome was the clinical response rate, the secondary outcome was the overall mortality, and nephrotoxicity. The publication bias was evaluated using the Egger's test. RESULTS: Of the total 279 articles, nine were finally included in the final analysis. There was a significant difference between the adjunctive AS colistin group and the IV colistin monotherapy group for the treatment-response rate (odds ratio (OR), 1.56; 95% CI, 1.14–2.14; p = 0.005; I² = 36%), although there was no significant difference in overall mortality (OR, 0.77; 95% CI, 0.57–1.04; p = 0.09; I² = 20%). However, there was no significant difference between the two groups in nephrotoxicity (OR, 1.13; 95% CI, 0.74–1.74; p = 0.57; I² = 4%). CONCLUSION: The addition of aerosolized colistin to IV colistin monotherapy showed better results in terms of efficacy than IV colistin monotherapy and did not show any significant difference in terms of total mortality and nephrotoxicity. Additional large-scale studies of this need to be verified.