Aspiration pneumonia medical therapy

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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 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 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 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

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 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

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