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]

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].

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 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

The best approach is to remove the foreign body by fiberoptic or rigid bronchoscopy.

For pneumonia medical therapy, click here.

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For pleural empyema medical therapy, click here.