Aspiration Pneumonia

 AUGUST 12, 2023 RESPIRATORY 0 COMMENTS

Term	Definition	Is antibiotic therapy required?
Aspiration	The inhalation of foreign material (eg food, vomit, blood, saliva) into the lungs. Predisposing: – Impaired consciousness eg due to: trauma, stroke, general anaesthetic, seizure, overdose, alcohol or drug intoxication – Esophageal dysmotility – Post-bronchial obstruction – Gum disease – neurological disorders	NoMonitor the patient for signs of aspiration pneumonitis and aspiration pneumonia
Aspiration Event	A clear or witnessed episode of aspiration (eg aspiration of vomit during a seizure).	NoMonitor the patient for signs of aspiration pneumonitis and aspiration pneumonia
Aspiration Pneumonitis	Acute chemical injury to the lung parenchyma after aspiration of acidic stomach contents without Bacterial infectionAlso known as chemical pneumonitis or Mendelson syndrome. Symptoms: – Abrupt onset (2hrs) – key difference between aspiration pneumonitis and aspiration pneumonia – Low grade fever – ↑ WBC – Hypoxemia CXR consolidation : (RML/RLL upright, RUL supine) → may be indistinguishable from pneumonia in the acute setting! Severity ranges from mild symptoms such as cough or wheeze to severe acute respiratory distress syndrome (ARDS). In most patients, symptoms improve quickly (usually within 24 to 48 hours).	No.Closely monitor the patient for deterioration.If unable to differentiate between aspiration pneumonitis and aspiration pneumonia, start antibiotic therapy and review within 24 to 48 hoursConsider stopping antibiotic therapy if the patient has significantly improved and aspiration pneumonitis is a more likely diagnosis.For information on aspiration pneumonitis in cases of poisoning (overdose), see Aspiration pneumonitis due to poisoning.
Aspiration Pneumonia	A bacterial infection caused by aspiration of organisms from the oropharynx. oral anaerobes – Peptostreptococcus – Fusobacterium – Bacteroides GNRs standard CAP/HAP organisms. Characteristics: – Symptom onset is delayed (this differentiates aspiration pneumonia from aspiration pneumonitis) – Indolent, putrid sputum – pulmonary necrosis w/ cavitation/abscess/empyema – tachypnoea at rest – tachycardia – persistent fever – rigors – hypoxaemia or crepitations (crackles) on auscultation that do not clear with coughing.	YesAnaerobic Coverage

Management for Aspiration Pneumonia:

1. First-Line Antibiotics:
   • Amoxicillin: 1 g (child: 25 mg/kg up to 1 g) orally or enterally, 8-hourly.
   • Plus Metronidazole: 400 mg (child: 10 mg/kg up to 400 mg) orally or enterally, 12-hourly.
2. Alternative Antibiotics:
   • Amoxicillin+Clavulanate: 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally or enterally, 12-hourly.
   • Clindamycin: 450 mg (child: 10 mg/kg up to 450 mg) orally or enterally, 8-hourly.
   • Moxifloxacin: 400 mg (child: 10 mg/kg up to 400 mg) orally or enterally, daily.
3. For Penicillin Hypersensitivity:
   • Use Clindamycin or Moxifloxacin as per the dosages above.

Strategies to manage dysphagia and protect the upper airway:

1. swallowing rehabilitation with a speech pathologist
2. oral hygiene
3. immunisation against Streptococcus pneumoniae—see the Australian Immunisation Handbook [URL]
4. management of gastro-oesophageal reflux—see Gastro-oesophageal reflux
5. positioning the patient to minimise aspiration (eg elevating the head of the bed)
6. insertion of a percutaneous endoscopic gastrostomy (PEG) tub