Aspiration pneumo guidelines

Clinical findings:

o Immediate symptoms: bronchospasms; , crackles on auscultation, hypoxemia with

cyanosis
o Late symptoms: fever, shortness of breath, cough with foul-smelling sputum
o Manisfestations: chemical pneumonitis, bacterial infection, airway
obstruction.

Diagnosis

o Radiologic imaging: infiltrates visible in lung regions according to body position

on aspiration
o Arterial blood gas analysis (↓ PaO2, pH < 7.35, PaCO2 > 45 mm Hg)

Management

 Immediate tracheal suction to clear fluids and matter to relieve obstruction and analyze
the secretions
 Severe ill pts->empiric treatment. Stop if no ilfiltrates after 48 to 72 hrs.
 Anaerobic bacteria are causative organisms and if parental therapy req/duse ampicillin-
sulbactem (1.5 to 3 g IV every 6 hs) is first line.
 Pts w/ mild sxs and can tolerate oral medsgive amoxic-clavulanate (875 mg twice
daily).
 Regular monitoring: arterial blood gas, CT scan.
 Percutaneous endoscopic gastrotomy tubes and NG tubes are best for delivery nutrition
and oral meds in pts w/ dysphagia.

Assess medical hx: Antibiotics administered in the past 90 days generally should not be
prescribed again, because the risk of infection with resistant pathogens is increased.37
Treatment: Intravenous antimicrobial therapy should be initiated for nursing home
patients hospitalized with pneumonia, with empiric coverage of methicillin-resistant S.
aureus (MRSA) and Pseudomonas aeruginosaAn anti-MRSA agent (vancomycin or
linezolid).

●For hospital-acquired aspiration pneumonia, most authorities feel that the companion
aerobic bacteria, especially gram-negative bacilli and Staphylococcus aureus, are more
important than the anaerobes, are generally easily detected with heavy growth from
adequate specimens, and that therapy should be directed at these organisms.
However, in patients with poor dentition, we generally use a regimen with activity
against both aerobes and anaerobes. When there is a perceived need to treat anaerobic
bacteria as well as the aerobic gram-negative bacilli, we suggest imipenem,
meropenem, or piperacillin-tazobactam since these agents will cover virtually all
anaerobes as well as most aerobic gram-negative bacilli (Grade 2B).

In patients with risk factors for methicillin-resistant Staphylococcus aureus (MRSA; eg,
colonization with MRSA), we also suggest an agent with activity against MRSA
(vancomycin or linezolid) (Grade 2B), but, if MRSA is not detected, then this agent
should be discontinued. (See 'Choice of regimen' above and "Treatment of hospital-
acquired and ventilator-associated pneumonia in adults".)

●Patients who are initially treated with parenteral antibiotics can be switched to oral
antibiotics when they are improving clinically, hemodynamically stable, able to take oral
medications, and have a normally functioning gastrointestinal tract. For most patients,
we suggest amoxicillin-clavulanate (875 mg orally twice daily) (Grade 2B). For patients
who have a serious allergy (eg, an IgE-mediated reaction) to penicillin, we suggest
clindamycin (450 mg orally three times daily)