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Aspiration Pneumonia
Empiric Treatment

Empiric Treatment

Initial Recommendations

If fever, tachypnea & new onset hypoxemia symptoms are present, then:

  • Obtain sputum culture and CXR
  • Assess level of respiratory reserve

If poor respiratory reserve, begin treatment for pneumonia

  • BMI below 20
  • Chronic CO₂ Retention
  • Home O₂
  • Severe COPD
  • Pulmonary hypertension

If Poor Respiratory Reserve

OR

OR, if critically ill

SEVERE Beta-lactam Allergy

+/-

Metronidazole 500 mg PO BID
​

If additional risk factors for "anaerobic coverage". See section in "Ongoing Management" below

Duration of Therapy

5-7 days

Ongoing Management

Reassess daily

  • Discontinue antibiotics if rapid improvement and antibiotics started without a watch and wait period
  • Adjust antibiotics based on culture results
  • Antibiotics that are typically used in CAP, would also cover the usual organisms involved in pneumonia caused by aspiration. No additional anaerobic antibiotic coverage is needed
  • Anaerobic coverage should be included if patient at risk for anaerobes:
    • loss of consciousness (i.e. overdose, seizures) PLUS esophageal motility disorder
    • necrotizing pneumonia
    • lung abscess