Aspiration pneumonia

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Aspiration pneumonia

This can reflect chemical injury and does not always indicate antibiotic treatment

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

Severity assessment

CURB65 score (see Community acquired pneumonia) can be used to assess severity.

CURB65 < 3 = low severity. CURB65 > 3 = high severity

Required investigations

Chest X-ray PLUS in high severity disease:

  • Blood culture
  • Sputum for culture; TRAK as 'C&S-Respiratory (Routine Bacteriology)'
  • Viral throat swab if being admitted (swab throat and nose at same time with single swab, send in viral transport medium); TRAK as 'Resp Virus Screen' 

Low severity antibiotic recommendation

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

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

Penicillin Allergy

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

OR (if renal impairment)

Doxycycline 200mg on day one then 100mg daily orally

 

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 1g 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

OR (if renal impairment)

Doxycycline 200mg on day one the 100mg daily orally

PLUS

Metronidazole 400mg every 8 hours orally