Aspiration pneumonia medical therapy: Difference between revisions

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__NOTOC__
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{{Aspiration pneumonia}}
{{Aspiration pneumonia}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{SSH}}


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There are different approaches for different classes of aspiration pneumonia. [[Pneumonitis]] and [[Infection|bacterial infection]] require [[Antibiotic|antibiotic therapy]], while [[foreign body]] aspiration and mechanical [[obstruction]] may need invasive interventions. [[Chemical pneumonitis]] must be treated supportively. Immediate clearing of the [[respiratory tract]] from aspirated material and fluid by [[suction]] must be the first step if the diagnosis of aspiration is definite. Pharmacologic medical therapy for aspiration pneumonia includes [[Antibiotic|antibiotics]] such as [[Ampicillin-Sulbactam|ampicillin-sulbactam]], [[Amoxicillin-Clavulanate|amoxicillin-clavulanate]], or [[clindamycin]] for 7 days. Alternative regimens include combination of [[metronidazole]] with [[Penicillin G benzathine|penicillin G]], [[amoxicillin]], [[ceftriaxone]], or [[Cefotaxime sodium|cefotaxime]]. [[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.


OR
==Medical Therapy==
 
*There are different pharmacologic approaches for different classes of aspiration pneumonia. [[Pneumonitis]] and [[Infection|bacterial infection]] require [[Antibiotic|antibiotic therapy]], while [[foreign body]] aspiration and mechanical [[obstruction]] may need invasive interventions.<ref name="DiBardinoWunderink2015">{{cite journal|last1=DiBardino|first1=David M.|last2=Wunderink|first2=Richard G.|title=Aspiration pneumonia: A review of modern trends|journal=Journal of Critical Care|volume=30|issue=1|year=2015|pages=40–48|issn=08839441|doi=10.1016/j.jcrc.2014.07.011}}</ref><ref name="HuLee2015">{{cite journal|last1=Hu|first1=Xiaowen|last2=Lee|first2=Joyce S.|last3=Pianosi|first3=Paolo T.|last4=Ryu|first4=Jay H.|title=Aspiration-Related Pulmonary Syndromes|journal=Chest|volume=147|issue=3|year=2015|pages=815–823|issn=00123692|doi=10.1378/chest.14-1049}}</ref><ref name="Marik20012">{{cite journal|last1=Marik|first1=Paul E.|title=Aspiration Pneumonitis and Aspiration Pneumonia|journal=New England Journal of Medicine|volume=344|issue=9|year=2001|pages=665–671|issn=0028-4793|doi=10.1056/NEJM200103013440908}}</ref><ref name="pmid19857224">{{cite journal| author=Japanese Respiratory Society| title=Aspiration pneumonia. | journal=Respirology | year= 2009 | volume= 14 Suppl 2 | issue=  | pages= S59-64 | pmid=19857224 | doi=10.1111/j.1440-1843.2009.01578.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19857224  }}</ref><ref name="pmid23052002">{{cite journal| author=Almirall J, Cabré M, Clavé P| title=Complications of oropharyngeal dysphagia: aspiration pneumonia. | journal=Nestle Nutr Inst Workshop Ser | year= 2012 | volume= 72 | issue=  | pages= 67-76 | pmid=23052002 | doi=10.1159/000339989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23052002  }}</ref><ref name="pmid9925081">{{cite journal| author=Marik PE, Careau P| title=The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. | journal=Chest | year= 1999 | volume= 115 | issue= 1 | pages= 178-83 | pmid=9925081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9925081  }}</ref>
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
*[[Chemical pneumonitis]] must be treated supportively. Immediate clearing the [[respiratory tract]] from aspirated material and fluid by [[suction]] must be the first step if the diagnosis of aspiration is definite.
 
*Pharmacologic medical therapy for aspiration pneumonia includes [[Antibiotic|antibiotics]] such as [[Ampicillin-Sulbactam|ampicillin-sulbactam]], [[Amoxicillin-Clavulanate|amoxicillin-clavulanate]], or [[clindamycin]] for 7 days.  
OR
*Alternative regimens include combination of [[metronidazole]] with [[Penicillin G benzathine|penicillin G]], [[amoxicillin]], [[ceftriaxone]], or [[Cefotaxime sodium|cefotaxime]].
 
*[[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.
The majority of cases of [disease name] are self-limited and require only supportive care.
===Aspiration pneumonia===
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR


[Therapy] is recommended among all patients who develop [disease name].
* '''1 Chemical pneumonitis'''
** 1.1 '''Adult'''
*** Preferred regimen (1): [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days
*** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days
*** Preferred regimen (3): High molecular weight colloids IV
*** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days
*** Alternative regimen (2): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[Penicillin G benzathine|penicillin G]] 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[amoxicillin]] 500 mg PO q8h for 7 days
*** Alternative regimen (4): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[ceftriaxone]] 1-2 g IV qd for 7 days
*** Alternative regimen (5): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[Cefotaxime sodium|cefotaxime]] 1-2 g IV q8h for 7 days
::'''Note (1):''' Immediate clearing of the [[respiratory tract]] from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite.  


OR
::'''Note (2):''' [[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.


Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
:::'''Note (3):''' The use of [[glucocorticoids]] for aspiration pneumonia is controversial.  
 
* '''2 Bacterial infection'''
OR
** 2.1 '''Adult'''
 
*** Preferred regimen (1):[[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days
 
*** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days
OR
*** Alternative regimen (2): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[Penicillin G benzathine|penicillin G]] 1-2 million units IV q4-6h for 7 days
 
*** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[amoxicillin]] 500 mg PO q8h for 7 days
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*** Alternative regimen (4): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[ceftriaxone]] 1-2 g IV qd for 7 days
 
*** Alternative regimen (5): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[Cefotaxime sodium|cefotaxime]] 1-2 g IV q8h for 7 days
OR
***
 
'''For pneumonia medical therapy, click [[Pneumonia medical therapy|here]].'''
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===


* '''1 Stage 1 - Name of stage'''
'''For lung abscess medical therapy, click [[Lung abscess medical therapy|here]].'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. ''''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)


* 2 '''Stage 2 - Name of stage'''
'''For pleural empyema medical therapy, click [[Pleural empyema medical therapy|here]].'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 23:32, 29 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

There are different approaches for different classes of aspiration pneumonia. Pneumonitis and bacterial infection require antibiotic therapy, while foreign body aspiration and mechanical obstruction may need invasive interventions. Chemical pneumonitis must be treated supportively. Immediate clearing of the respiratory tract from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite. Pharmacologic medical therapy for aspiration pneumonia includes antibiotics such as ampicillin-sulbactam, amoxicillin-clavulanate, or clindamycin for 7 days. Alternative regimens include combination of metronidazole with penicillin G, amoxicillin, ceftriaxone, or cefotaxime. Positive pressure ventilation with 100% oxygen to support pulmonary function is sometimes required.

Medical Therapy

Aspiration pneumonia

Note (1): Immediate clearing of the respiratory tract from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite.
Note (2): Positive pressure ventilation with 100% oxygen to support pulmonary function is sometimes required.
Note (3): The use of glucocorticoids for aspiration pneumonia is controversial.

For pneumonia medical therapy, click here.

For lung abscess medical therapy, click here.

For pleural empyema medical therapy, click here.

References

  1. ↑ DiBardino, David M.; Wunderink, Richard G. (2015). "Aspiration pneumonia: A review of modern trends". Journal of Critical Care. 30 (1): 40–48. doi:10.1016/j.jcrc.2014.07.011. ISSN 0883-9441.
  2. ↑ Hu, Xiaowen; Lee, Joyce S.; Pianosi, Paolo T.; Ryu, Jay H. (2015). "Aspiration-Related Pulmonary Syndromes". Chest. 147 (3): 815–823. doi:10.1378/chest.14-1049. ISSN 0012-3692.
  3. ↑ Marik, Paul E. (2001). "Aspiration Pneumonitis and Aspiration Pneumonia". New England Journal of Medicine. 344 (9): 665–671. doi:10.1056/NEJM200103013440908. ISSN 0028-4793.
  4. ↑ Japanese Respiratory Society (2009). "Aspiration pneumonia". Respirology. 14 Suppl 2: S59–64. doi:10.1111/j.1440-1843.2009.01578.x. PMID 19857224.
  5. ↑ Almirall J, Cabré M, Clavé P (2012). "Complications of oropharyngeal dysphagia: aspiration pneumonia". Nestle Nutr Inst Workshop Ser. 72: 67–76. doi:10.1159/000339989. PMID 23052002.
  6. ↑ Marik PE, Careau P (1999). "The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study". Chest. 115 (1): 178–83. PMID 9925081.

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