Aspiration pneumonia

Note

Aspiration pneumonitis occurs within hours of aspiration often associated with a CXR infiltrate and impaired oxygenation.

Aspiration pneumonitis per se does NOT require antibiotics.

Aspiration pneumonia follows in only 1/4 of patients and generally occurs at least 36h after the aspiration event.

Thus, reasonable to withhold treatment unless patients develop new signs of infection such as elevated WBC and fever at ~36-48h

In patients who are very ill with minimal physiologic reserve it is reasonable to treat aspiration pneumonitis with antibiotics to PREVENT subsequent pneumonia.

Duration of Therapy

Treatment generally 7d, but may require prolonged therapy if lung abscess develops

Community Acquired

(Aspiration event occurred within 72h of admission)

Amoxicillin-Clavulinate 875mg PO BID monotherapy

OR

Metronidazole 500mg PO/IV BID

AND EITHER

Cefuroxime 500mg PO BID

OR

Cefazolin 2g IV q8h

OR

For penicillin allergic patients can use clindamycin 450mg PO/IV q8h

Hospital Acquired

(Aspiration event occurred >72h after admission)

Oral: Amoxicillin-Clavulinate 875mg PO BID

OR

IV: Piperacillin-Tazobactam 3.375g IV q6h