Aspiration pneumonia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Medical Therapy
- Management of patients with swallowing dysfunction is individualized based on the cause of the dysfunction.
- Patients with swallowing dysfunction is secondary to a transient disease need total parenteral nutrition or nasogastric tube to meet the caloric requirements.
- The benefits from the feeding plan is to provide efficient nutrition with preserved stable respiratory function.
- 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 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 tubes can be useful for administering medication and fluid, when needed.
- Antibiotic agents with activity against gram-negative organisms, such as 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 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.