Important: Therapy
The acute aspiration of stomach content in patients unable to protect their airway due to unconsciousness causes chemical pneumonitis and does not respond to antimicrobial treatment.
Aspiration in CAP or HAP
Duration
5 days
Important: Therapy
Treat as community-acquired pneumonia or hospital-acquired pneumonia (if hospital admission in last 6 weeks or current in-patient for >48hrs) with the addition of metronidazole to cover oral anaerobic organisms.
Add Metronidazole PO 400mg every 8 hours or IV 500mg every 8 hours for anaerobic cover to the following:
- amoxicillin
- clarithromycin
- doxycycline
- co-trimoxazole
- levofloxacin
- amoxicillin and temocillin
Notes:
True aspiration pneumonia arises from continuous microaspiration of upper respiratory tract secretions in patients with swallowing difficulties.
If the patient is already receiving Co-Amoxiclav, piperacillin-tazobactam or meropenem due to known resistant organisms or on Infection Specialist advice, the addition of metronidazole is not required, as these agents provide anaerobic cover.