Aspiration pneumonia medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(6 intermediate revisions by one other user not shown)
Line 4: Line 4:


==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
There are different approaches for different classes of aspiration pneumonia. [[Pneumonitis]] and [[Infection|bacterial infection]] require [[Antibiotic|antibiotic therapy]], while [[foreign body]] aspiration and mechanical [[obstruction]] may need invasive interventions. [[Chemical pneumonitis]] must be treated supportively. Immediate clearing of the [[respiratory tract]] from aspirated material and fluid by [[suction]] must be the first step if the diagnosis of aspiration is definite. Pharmacologic medical therapy for aspiration pneumonia includes [[Antibiotic|antibiotics]] such as [[Ampicillin-Sulbactam|ampicillin-sulbactam]], [[Amoxicillin-Clavulanate|amoxicillin-clavulanate]], or [[clindamycin]] for 7 days. Alternative regimens include combination of [[metronidazole]] with [[Penicillin G benzathine|penicillin G]], [[amoxicillin]], [[ceftriaxone]], or [[Cefotaxime sodium|cefotaxime]]. [[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


==Medical Therapy==
==Medical Therapy==
*There are different approaches for different classes of aspiration pneumonia.  
*There are different pharmacologic approaches for different classes of aspiration pneumonia. [[Pneumonitis]] and [[Infection|bacterial infection]] require [[Antibiotic|antibiotic therapy]], while [[foreign body]] aspiration and mechanical [[obstruction]] may need invasive interventions.<ref name="DiBardinoWunderink2015">{{cite journal|last1=DiBardino|first1=David M.|last2=Wunderink|first2=Richard G.|title=Aspiration pneumonia: A review of modern trends|journal=Journal of Critical Care|volume=30|issue=1|year=2015|pages=40–48|issn=08839441|doi=10.1016/j.jcrc.2014.07.011}}</ref><ref name="HuLee2015">{{cite journal|last1=Hu|first1=Xiaowen|last2=Lee|first2=Joyce S.|last3=Pianosi|first3=Paolo T.|last4=Ryu|first4=Jay H.|title=Aspiration-Related Pulmonary Syndromes|journal=Chest|volume=147|issue=3|year=2015|pages=815–823|issn=00123692|doi=10.1378/chest.14-1049}}</ref><ref name="Marik20012">{{cite journal|last1=Marik|first1=Paul E.|title=Aspiration Pneumonitis and Aspiration Pneumonia|journal=New England Journal of Medicine|volume=344|issue=9|year=2001|pages=665–671|issn=0028-4793|doi=10.1056/NEJM200103013440908}}</ref><ref name="pmid19857224">{{cite journal| author=Japanese Respiratory Society| title=Aspiration pneumonia. | journal=Respirology | year= 2009 | volume= 14 Suppl 2 | issue=  | pages= S59-64 | pmid=19857224 | doi=10.1111/j.1440-1843.2009.01578.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19857224  }}</ref><ref name="pmid23052002">{{cite journal| author=Almirall J, Cabré M, Clavé P| title=Complications of oropharyngeal dysphagia: aspiration pneumonia. | journal=Nestle Nutr Inst Workshop Ser | year= 2012 | volume= 72 | issue=  | pages= 67-76 | pmid=23052002 | doi=10.1159/000339989 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23052002  }}</ref><ref name="pmid9925081">{{cite journal| author=Marik PE, Careau P| title=The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. | journal=Chest | year= 1999 | volume= 115 | issue= 1 | pages= 178-83 | pmid=9925081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9925081  }}</ref>
*Chemical pneumonitis must be treated supportively.  
*[[Chemical pneumonitis]] must be treated supportively. Immediate clearing the [[respiratory tract]] from aspirated material and fluid by [[suction]] must be the first step if the diagnosis of aspiration is definite.
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapy for aspiration pneumonia includes [[Antibiotic|antibiotics]] such as [[Ampicillin-Sulbactam|ampicillin-sulbactam]], [[Amoxicillin-Clavulanate|amoxicillin-clavulanate]], or [[clindamycin]] for 7 days.  
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Alternative regimens include combination of [[metronidazole]] with [[Penicillin G benzathine|penicillin G]], [[amoxicillin]], [[ceftriaxone]], or [[Cefotaxime sodium|cefotaxime]].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*[[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Aspiration pneumonia===
===Disease Name===


* '''1 Chemical pneumonitis'''
* '''1 Chemical pneumonitis'''
** 1.1 '''Adult'''
** 1.1 '''Adult'''
*** Preferred regimen (1): ampicillin-sulbactam 1.5-3 g IV q6h for 7 days
*** Preferred regimen (1): [[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days
*** Preferred regimen (2): amoxicillin-clavulanate 875 mg PO q12h for 7 days
*** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days
*** Preferred regimen (3): high molecular weight colloids IV
*** Preferred regimen (3): High molecular weight colloids IV
*** Alternative regimen (1): clindamycin 600 mg IV q8h (for penicillin-allergic patients) for 7 days
*** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days
*** Alternative regimen (2): metronidazole 500 mg PO or IV q8h plus penicillin G 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (2): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[Penicillin G benzathine|penicillin G]] 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
*** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[amoxicillin]] 500 mg PO q8h for 7 days
*** Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
*** Alternative regimen (4): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[ceftriaxone]] 1-2 g IV qd for 7 days
*** Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus cefotaxime 1-2 g IV q8h for 7 days
*** Alternative regimen (5): [[Metronidazole]] 500 mg PO or IV q8h <u>'''AND'''</u> [[Cefotaxime sodium|cefotaxime]] 1-2 g IV q8h for 7 days
Note (1): Immediate clearing the respiratory tract from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite.  
::'''Note (1):''' Immediate clearing of the [[respiratory tract]] from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite.  
Note (2): Positive-pressure ventilation with 100% oxygen combined with isoproterenol to support pulmonary function is sometimes required.
 
Note (3): The use of glucocorticoids for aspiration pneumonia is controversial.  
::'''Note (2):''' [[Positive pressure ventilation]] with 100% [[oxygen]] to support [[Lung|pulmonary]] function is sometimes required.  
 
:::'''Note (3):''' The use of [[glucocorticoids]] for aspiration pneumonia is controversial.  
* '''2 Bacterial infection'''
* '''2 Bacterial infection'''
** 2.1 '''Adult'''
** 2.1 '''Adult'''
*** Preferred regimen (1): ampicillin-sulbactam 1.5-3 g IV q6h for 7 days
*** Preferred regimen (1):[[Ampicillin-Sulbactam|Ampicillin-sulbactam]] 1.5-3 g IV q6h for 7 days
*** Preferred regimen (2): amoxicillin-clavulanate 875 mg PO q12h for 7 days
*** Preferred regimen (2): [[Amoxicillin-Clavulanate|Amoxicillin-clavulanate]] 875 mg PO q12h for 7 days
*** Alternative regimen (1): clindamycin 600 mg IV q8h (for penicillin-allergic patients) for 7 days
*** Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h (for [[Penicillin allergy|penicillin allergic]] patients) for 7 days
*** Alternative regimen (2): metronidazole 500 mg PO or IV q8h plus penicillin G 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (2): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[Penicillin G benzathine|penicillin G]] 1-2 million units IV q4-6h for 7 days
*** Alternative regimen (3): metronidazole 500 mg PO or IV q8h plus amoxicillin 500 mg PO q8h for 7 days
*** Alternative regimen (3): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[amoxicillin]] 500 mg PO q8h for 7 days
*** Alternative regimen (4): metronidazole 500 mg PO or IV q8h plus ceftriaxone 1-2 g IV qd for 7 days
*** Alternative regimen (4): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[ceftriaxone]] 1-2 g IV qd for 7 days
*** Alternative regimen (5): metronidazole 500 mg PO or IV q8h plus cefotaxime 1-2 g IV q8h for 7 days
*** Alternative regimen (5): [[Metronidazole]] 500 mg PO or IV q8h '''AND''' [[Cefotaxime sodium|cefotaxime]] 1-2 g IV q8h for 7 days
* '''3 Foreign body aspiration'''
***
Note: The best approach is to remove the foreign body by fiberoptic or rigid bronchoscopy.
'''For pneumonia medical therapy, click [[Pneumonia medical therapy|here]].'''
{{#ev:youtube|0eQlO6o_nY8}}
 
* '''3 Foreign body aspiration'''
'''For lung abscess medical therapy, click [[Lung abscess medical therapy|here]].'''
 
'''For pleural empyema medical therapy, click [[Pleural empyema medical therapy|here]].'''


==References==
==References==

Latest revision as of 23:32, 29 April 2018

Aspiration pneumonia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aspiration Pneumonia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Aspiration pneumonia medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aspiration pneumonia medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aspiration pneumonia medical therapy

CDC onAspiration pneumonia medical therapy

Aspiration pneumonia medical therapy in the news

Blogs on Aspiration pneumonia medical therapy

Directions to Hospitals Treating Pneumonia

Risk calculators and risk factors for Aspiration pneumonia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

There are different approaches for different classes of aspiration pneumonia. Pneumonitis and bacterial infection require antibiotic therapy, while foreign body aspiration and mechanical obstruction may need invasive interventions. Chemical pneumonitis must be treated supportively. Immediate clearing of the respiratory tract from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite. Pharmacologic medical therapy for aspiration pneumonia includes antibiotics such as ampicillin-sulbactam, amoxicillin-clavulanate, or clindamycin for 7 days. Alternative regimens include combination of metronidazole with penicillin G, amoxicillin, ceftriaxone, or cefotaxime. Positive pressure ventilation with 100% oxygen to support pulmonary function is sometimes required.

Medical Therapy

Aspiration pneumonia

Note (1): Immediate clearing of the respiratory tract from aspirated material and fluid by suction must be the first step if the diagnosis of aspiration is definite.
Note (2): Positive pressure ventilation with 100% oxygen to support pulmonary function is sometimes required.
Note (3): The use of glucocorticoids for aspiration pneumonia is controversial.

For pneumonia medical therapy, click here.

For lung abscess medical therapy, click here.

For pleural empyema medical therapy, click here.

References

  1. DiBardino, David M.; Wunderink, Richard G. (2015). "Aspiration pneumonia: A review of modern trends". Journal of Critical Care. 30 (1): 40–48. doi:10.1016/j.jcrc.2014.07.011. ISSN 0883-9441.
  2. Hu, Xiaowen; Lee, Joyce S.; Pianosi, Paolo T.; Ryu, Jay H. (2015). "Aspiration-Related Pulmonary Syndromes". Chest. 147 (3): 815–823. doi:10.1378/chest.14-1049. ISSN 0012-3692.
  3. Marik, Paul E. (2001). "Aspiration Pneumonitis and Aspiration Pneumonia". New England Journal of Medicine. 344 (9): 665–671. doi:10.1056/NEJM200103013440908. ISSN 0028-4793.
  4. Japanese Respiratory Society (2009). "Aspiration pneumonia". Respirology. 14 Suppl 2: S59–64. doi:10.1111/j.1440-1843.2009.01578.x. PMID 19857224.
  5. Almirall J, Cabré M, Clavé P (2012). "Complications of oropharyngeal dysphagia: aspiration pneumonia". Nestle Nutr Inst Workshop Ser. 72: 67–76. doi:10.1159/000339989. PMID 23052002.
  6. Marik PE, Careau P (1999). "The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study". Chest. 115 (1): 178–83. PMID 9925081.

Template:WH Template:WS