Aspiration pneumonia medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
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 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. | 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. | ||
==Medical Therapy== | ==Medical Therapy== | ||
*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.<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> | *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> | ||
*[[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. | *[[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. | *Pharmacologic medical therapy for aspiration pneumonia includes [[Antibiotic|antibiotics]] such as [[Ampicillin-Sulbactam|ampicillin-sulbactam]], [[Amoxicillin-Clavulanate|amoxicillin-clavulanate]], or [[clindamycin]] for 7 days. | ||
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* '''1 Chemical pneumonitis''' | * '''1 Chemical pneumonitis''' | ||
** 1.1 '''Adult''' | ** 1.1 '''Adult''' | ||
*** Preferred regimen (1): [[Ampicillin-Sulbactam| | *** Preferred regimen (1): [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days | ||
*** Preferred regimen (2): [[Amoxicillin-Clavulanate| | *** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days | ||
*** Preferred regimen (3): | *** Preferred regimen (3): High molecular weight colloids IV | ||
*** Alternative regimen (1): [[ | *** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days | ||
*** Alternative regimen (2): [[ | *** 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): [[ | *** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[amoxicillin]] 500 mg PO q8h for 7 days | ||
*** Alternative regimen (4): [[ | *** 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): [[ | *** 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 the [[respiratory tract]] from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite. | ::'''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 [[Lung|pulmonary]] function is sometimes required. | ::'''Note (2):''' [[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required. | ||
Note (3): The use of [[glucocorticoids]] for aspiration pneumonia is controversial. | :::'''Note (3):''' The use of [[glucocorticoids]] for aspiration pneumonia is controversial. | ||
* '''2 Bacterial infection''' | * '''2 Bacterial infection''' | ||
** 2.1 '''Adult''' | ** 2.1 '''Adult''' | ||
*** Preferred regimen (1): [[Ampicillin-Sulbactam| | *** Preferred regimen (1):[[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days | ||
*** Preferred regimen (2): [[Amoxicillin-Clavulanate| | *** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days | ||
*** Alternative regimen (1): [[ | *** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days | ||
*** Alternative regimen (2): [[ | *** 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): [[ | *** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[amoxicillin]] 500 mg PO q8h for 7 days | ||
*** Alternative regimen (4): [[ | *** Alternative regimen (4): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[ceftriaxone]] 1-2 g IV qd for 7 days | ||
*** Alternative regimen (5): [[ | *** Alternative regimen (5): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[Cefotaxime sodium|cefotaxime]] 1-2 g IV q8h for 7 days | ||
*** | |||
'''For pneumonia medical therapy, click [[Pneumonia medical therapy|here]].''' | '''For pneumonia medical therapy, click [[Pneumonia medical therapy|here]].''' | ||
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
- There are different pharmacologic 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.[1][2][3][4][5][6]
- 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 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.
Aspiration pneumonia
- 1 Chemical pneumonitis
- 1.1 Adult
- Preferred regimen (1): Ampicillin-sulbactam 1.5-3 g IV q6h for 7 days
- Preferred regimen (2): 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 allergic patients) for 7 days
- Alternative regimen (2): Metronidazole 500 mg PO or IV q8h AND 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
- 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 1-2 g IV q8h for 7 days
- 1.1 Adult
- 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.
- 2 Bacterial infection
- 2.1 Adult
- Preferred regimen (1):Ampicillin-sulbactam 1.5-3 g IV q6h for 7 days
- Preferred regimen (2): Amoxicillin-clavulanate 875 mg PO q12h for 7 days
- Alternative regimen (1): Clindamycin 600 mg IV q8h (for penicillin allergic patients) for 7 days
- Alternative regimen (2): Metronidazole 500 mg PO or IV q8h AND 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
- 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 1-2 g IV q8h for 7 days
- 2.1 Adult
For pneumonia medical therapy, click here.
For lung abscess medical therapy, click here.
For pleural empyema medical therapy, click here.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Japanese Respiratory Society (2009). "Aspiration pneumonia". Respirology. 14 Suppl 2: S59–64. doi:10.1111/j.1440-1843.2009.01578.x. PMID 19857224.
- ↑ 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.
- ↑ 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.