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__NOTOC__
__NOTOC__
{{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.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
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].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
==Medical Therapy==
==Medical Therapy==
* Management of patients with swallowing dysfunction is individualized based on the cause of the dysfunction.
*There are different approaches for different classes of aspiration pneumonia.
* Patients with swallowing dysfunction is secondary to a transient disease need [[total parenteral nutrition]] or [[Nasogastric intubation|nasogastric tube]] to meet the caloric requirements.
*Chemical pneumonitis must be treated supportively.
* The benefits from the feeding plan is to provide efficient nutrition with preserved stable respiratory function.
*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 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 plus penicillin G 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
*** Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
*** Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus 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 (2): Positive-pressure ventilation with 100% oxygen combined with isoproterenol 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 plus penicillin G 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
*** Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
*** Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus cefotaxime 1-2 g IV q8h for 7 days
* '''3 Foreign body aspiration'''
Note: The best approach is to remove the foreign body by fiberoptic or rigid bronchoscopy.
{{#ev:youtube|0eQlO6o_nY8}}
* '''3 Foreign body aspiration'''


* The preferred treatment for infants and children with swallowing dysfunction is speech and occupational therapies to improve swallowing function.
* Other feeding techniques to prevent aspiration in infants include changes in the infant or child's position and posture during feeding, modification of bolus size, and alterations of consistency, shape, texture, and temperature of food. In children with delayed maturation, swallowing function may improve over time.
* Some patients will require [[percutaneous]] [[Gastrostomy|gastrostomy tubes]] to meet part or all of their nutritional needs for patients who are unable to safely use oral feeding.
* Parents may initially be reluctant to have a gastrostomy tube placed because of concerns about losing pleasure of eating, discomfort, or cosmesis. The importance of preventing pulmonary aspiration, long-term benefits of improved nutrition, and reversibility of this procedure should be emphasized. In addition, [[Gastrostomy|gastrostomy tubes]] can be useful for administering medication and fluid, when needed.
* Antibiotic agents with activity against [[Gram-negative bacteria|gram-negative organisms]], such as [[Cephalosporin|third-generation cephalosporins]], [[fluoroquinolones]], and [[piperacillin]], are usually required.
* '''Penicillin and [[clindamycin]]''', which are often called the standard antibiotic agents for aspiration pneumonia, are inadequate for most patients with aspiration pneumonia.
* [[Endotracheal intubation]] should be considered for patients who are unable to protect their airway.
* The prophylactic use of antibiotics in patients in whom aspiration is suspected or witnessed is not recommended.
* [[Empirical]] antibiotic therapy is appropriate for patients who aspirate gastric contents and who have [[Small bowel obstruction|small-bowel obstruction]] or other conditions associated with colonization of the gastric contents.
* Antibiotic therapy should be considered for patients with aspiration pneumonitis that fails to resolve within 48 hours after aspiration.
* [[Corticosteroids]] have been used for decades in the management of aspiration pneumonitis but there is no strong evidence about its benefit.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 23:15, 3 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 is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

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].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

  • There are different approaches for different classes of aspiration pneumonia.
  • Chemical pneumonitis must be treated supportively.
  • 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 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 plus penicillin G 1-2 million units IV q4-6h for 7 days
      • Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
      • Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
      • Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus 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 (2): Positive-pressure ventilation with 100% oxygen combined with isoproterenol 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 plus penicillin G 1-2 million units IV q4-6h for 7 days
      • Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
      • Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
      • Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus cefotaxime 1-2 g IV q8h for 7 days
  • 3 Foreign body aspiration

Note: The best approach is to remove the foreign body by fiberoptic or rigid bronchoscopy. {{#ev:youtube|0eQlO6o_nY8}}

  • 3 Foreign body aspiration

References

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