Background: Aerobic Gram-negative bacilli commonly cause severe respiratory infections. Multi-drug resistant pathogens are prevalent which makes choosing the most appropriate empiric therapy extremely challenging. Nebulized Amikacin attains substantial pulmonary concentrations, and achieve outstanding bactericidal efficacy in critically ill patients. Objective: to evaluate efficacy and safety of nebulized amikacin as an adjuvant therapy of Gram-negative pulmonary infections in chest care unit. Patients and Methods: 60 patients with pulmonary infections caused by Gram-negative bacteria developed in hospital settings in BeniSuefUniversity hospital from August 2019 to August 2021. They were divided into two groups: Group A received nebulized amikacin 25 mg/kg divided every 8-12h for 20 minutes and group B as a control received normal saline 5 ml at the same frequency. All participants received similar parenteral antibiotics. Aerosol treatment conducted for 7 days. Respiratory bacteriological samples obtained noninvasively. Results: Inhaled Amikacin could a statistically significant lower respiratory rate, the serum creatinine and improvement of the sputum culture growth in group A than group B. There was a statistically significant difference between the groups regarding their length of stay and their fate. There were 83.3% of cases at the end of the 1st week of follow up transformed into no growth sputum culture among the group A Conclusion: Inhaled amikacin had an adjuvant role in treatment of Hospital acquired pneumonia & Ventilator-associated pneumonia, as it was effective in rapid resolution of signs of respiratory infection, causing decreased bacterial load, decreased Intensive Care Unite stay and didn't cause elevation in serum creatinine.