GuidelinesEML (Adult Hospital STG)
Pneumonia, Aspiration
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
J69.0-1/J69.8
DESCRIPTION
- Following aspiration, a patient may develop pneumonitis or pneumonia.
- Aspiration pneumonitis develops within hours of the aspiration event and is more common in previously healthy people who aspirate gastric acid.
- Antibiotics will not benefit these patients unless infection is present.
- Pneumonia following aspiration of gastric contents and/or commensal organisms from the oropharynx usually occurs in debilitated patients and presents with symptoms and signs of community-acquired pneumonia. However, it may also have a more indolent onset, and is more frequently complicated by lung abscess or empyema.
- There may be solid (food) particles or other foreign bodies aspirated. The organisms involved are polymicrobial, i.e. Gram-positive and anaerobes. Aspiration pneumonia should be suspected in patients with episodic or prolonged decreased level of consciousness, e.g. in alcoholics, drug overdoses, epileptics, strokes, or those with swallowing problems.
MEDICINE TREATMENT
Antimicrobial therapy
Treatment duration: Continue therapy until there are no features of sepsis.
- Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly, until patient is apyrexial and stable for 24 hours.
Follow with:
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly.
LoE:III
Severe penicillin allergy: (Z88.0)
- Moxifloxacin, IV, 400 mg daily, until patient is apyrexial for 24 hours.
Follow with:
- Moxifloxacin, oral, 400 mg daily.
LoE:IIxlviii
If nosocomial infection is present (develops >48 hours post admission), see: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).
REFERRAL
- Hypoxaemia non-responsive to facemask oxygen.
- Suspected foreign body aspiration.
- Suspected chemical aspiration pneumonia.
- Non-resolving pneumonia.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.1_16 September 2024
Chapter 16: Respiratory Disorders _16.7 Pneumonia, Aspiration