Aspiration pneumonia
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
Look out for this icon: for treatment options that are affected, or added, as a result of your patient's comorbidities.
all patients
antibiotic therapy
For management of patients with suspected or confirmed COVID-19 pneumonia, see Coronavirus disease 2019 (COVID-19). Pneumonia due to COVID-19 is not covered in this topic.
Major pathogens are mixed aerobic and anaerobic mouth flora.
Anaerobic coverage is only required for patients with anaerobic pleuropulmonary syndrome (a later presentation of cavitary pneumonia or empyema associated with prior loss of consciousness and poor dental hygiene).[7]Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST http://www.ncbi.nlm.nih.gov/pubmed/31573350?tool=bestpractice.com Similarly, no additional anaerobic antimicrobial coverage is warranted for patients with dysphagia or aspiration associated with stroke.[44]Kishore AK, Jeans AR, Garau J, et al. Antibiotic treatment for pneumonia complicating stroke: recommendations from the pneumonia in stroke consensus (PISCES) group. Eur Stroke J. 2019 Dec;4(4):318-28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921946 http://www.ncbi.nlm.nih.gov/pubmed/31903430?tool=bestpractice.com
Therapy is the same as empiric therapy for non-aspiration pneumonia, whether it is community-acquired, hospital-acquired, or ventilator-associated.
The choice of oral or intravenous therapy is made on a case-by-case basis depending on the clinical condition of the patient and the ability of the patient to tolerate oral therapy.[7]Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST http://www.ncbi.nlm.nih.gov/pubmed/31573350?tool=bestpractice.com
Therapy is typically empiric, but should be tailored to the pathogen and its sensitivities if the pathogen is determined.
Recommended antibiotic regimens may differ between regions and local guidance should be consulted. Discussion with an infectious diseases specialist should inform the optimal regimen.
See Community-acquired pneumonia in adults (non COVID-19) and Hospital-acquired pneumonia (non COVID-19) for more detailed treatment information.
supportive care
Treatment recommended for ALL patients in selected patient group
It is important to correct any underlying problems that precipitated the aspiration.
Empyema, if present, may need drainage. Necrotizing lung abscess, if present, may be difficult to treat, and there are no clear data on when to manage medically versus surgically.
Other nonpharmacologic measures include oxygen, management of hypotension, and therapy for acute respiratory distress syndrome and septic shock if they ensue. If dysphagia is a concern, the patient should be kept nil per os (NPO) and a swallowing assessment should be organized.[12]Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003 Jul;124(1):328-36. http://www.ncbi.nlm.nih.gov/pubmed/12853541?tool=bestpractice.com [43]Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Dysphagia and aspiration in older people. Australas J Ageing. 2020 Mar;39(1):85. http://www.ncbi.nlm.nih.gov/pubmed/31313474?tool=bestpractice.com
There are no established criteria to determine hospital admission or level of care, and the decision needs to be based on clinical presentation. An intensive care unit admission is justified by patient intubation, hypotension, or altered mental status.
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
Use of this content is subject to our disclaimer