Aspiration pneumonia

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Only treat patients with evidence of pneumonia. Do not treat prophylactically.

Treat as high severity if two or more of:

  • low blood pressure (SBP≤100 mmHg),
  • high respiratory rate (≥22 breaths per min),
  • altered mentation (Glasgow coma scale <15)

Required investigations

Chest X-ray PLUS in high severity disease:

  • Blood culture
  • Sputum culture
  • Viral throat swab (swab throat and nose at same time with single swab, send in viral transport medium)

Low severity antibiotic recommendation

Recommended total duration: 5 days total duration = IV + oral

Amoxicillin  500mg 8 hourly orally (1g 8 hourly IV if oral route not available)

PLUS

Metronidazole 400mg every 8 hours orally (if oral route not available 500mg every 8 hours IV)

Penicillin Allergy

Co-trimoxazole  960mg every 12 hours orally (IV if oral route not available)

PLUS

Metronidazole 400mg every 8 hours orally (if oral route not available 500mg every 8 hours IV)

High severity antibiotic recommendation

Recommended total duration: 5 days (total duration = IV + oral)

Amoxicillin 1g every 8 hours IV

PLUS

Gentamicin IV (use NHS Lothian Calculator located on AMT intranet page)

PLUS

Metronidazole  500mg every 8 hours IV

Penicillin Allergy

Vancomycin IV (use NHS Lothian Calculator located  on AMT intranet page)

PLUS

Gentamicin IV (use NHS Lothian Calculator located AMT intranet page)

PLUS

Metronidazole 500mg every 8 hours IV

IV to oral switch

Amoxicillin 500mg every 8 hours orally

PLUS

Metronidazole  400mg every 8 hours orally

Penicillin Allergy

Co-trimoxazole 960mg every 12 hours orally

PLUS

Metronidazole  400mg every 8 hours orally

Notes

Likely organisms: Polymicrobial, H.influenzae, S.pneumoniae, M.catarrhalis.