Aspiration Pneumonia
Drug details
Mild to moderate
(IV route only if nil by mouth)
Oral metronidazole 400mg three times daily
OR IV metronidazole 500mg three times daily
PLUS Oral/IV amoxicillin 1g three times daily
7 days
Mild to moderate
If penicillin allergy:
Oral metronidazole 400mg three times daily
OR IV metronidazole 500mg three times daily
PLUS Oral/IV clarithromycin 500mg twice daily
7 days
Severe aspiration pneumonia
IV metronidazole 500mg three times daily
PLUS IV gentamicin - refer to NHS Highland gentamicin guidelines. Stop after three days if no evidence of gram negative infection
PLUS IV amoxicillin 1g three times daily
14 days
Severe
If penicillin allergy:
Oral/IV levofloxacin 500mg twice daily (see BNF warnings and MHRA Drug Safety Alert)
PLUS IV metronidazole 500mg three times daily
14 days
Severe
If MRSA likely or over 65 yrs:
ADD IV vancomycin - refer to NHS Highland vancomycin guidelines
14 days.
Change of pathogens compared to community-acquired infection. Pseudomonas sp, gram negative bacilli and MRSA are possibilities. Seek advice. Assess severity using SIRS criteria.
ASPIRATION PNEUMONITIS DOES NOT REQUIRE ANTIMICROBIAL THERAPY
Consider aspiration pneumonia if
Infection is indicated by change in sputum quality to purulent or mucopurulent or fever and new chest x-ray changes
For glossary of terms see Glossary