Antibiotics for Aspiration Pneumonia
Antibiotics To Treat Aspiration Pneumonia - Antibiotics used for Aspiration Pneumonia - Aspiration Pneumonia Treatment Antibiotics
Aspiration pneumonia develops after the inhalation of colonized oropharyngeal material. Aspiration of colonized secretions from the oropharynx is the primary mechanism by which bacteria gain entrance to the lungs. Indeed, Haemophilus influenzae and Streptococcus pneumoniae colonize the nasopharynx or oropharynx before they are aspirated and cause community-acquired pneumonia. The term “aspiration pneumonia,” however, refers specifically to the development of a radiographically evident infiltrate in patients who are at increased risk for oropharyngeal aspiration.
Approximately half of all healthy adults aspirate small amounts of oropharyngeal secretions during sleep. Presumably, the low burden of virulent bacteria in normal pharyngeal secretions, together with forceful coughing, active ciliary transport, and normal humoral and cellular immune mechanisms, results in clearance of the infectious material without sequelae. However, if these mechanical, humoral, or cellular mechanisms are impaired or if the amount of aspirated material is sufficiently large, pneumonia may follow.
Any condition that increases the volume or bacterial burden of oropharyngeal secretions in a person with impaired defense mechanisms may lead to aspiration pneumonia. Indeed, in patients who have had a stroke and are undergoing an evaluation of swallowing, there is a strong correlation between the volume of the aspirate and the development of pneumonia. Factors that increase the risk of oropharyngeal colonization with potentially pathogenic organisms and that increase the bacterial load may increase the risk of aspiration pneumonia. The risk of aspiration pneumonia is lower in patients without teeth40 and in elderly patients in institutional settings who receive aggressive oral care41 than in other patients. These risks largely distinguish aspiration pneumonia from community-acquired pneumonia. However, there is much overlap. For instance, otherwise healthy elderly patients with community-acquired pneumonia have a significantly higher incidence of silent aspiration than age-matched controls.
Treatment of Aspiration Pneumonia
The type of bacteria that caused the pneumonia depends on:
Antibiotics are used to treat aspiration pneumonia. Sometimes a person may need to go to the hospital to receive antibiotics directly into their veins through an IV (or intravenous catheter). In other cases, antibiotics taken by mouth may be used to treat the infection.
Antibiotics used for Aspiration Pneumonia
Antibiotic therapy is unequivocally indicated in patients with aspiration pneumonia. The choice of antibiotics should depend on the setting in which the aspiration occurs as well as the patient's general health. However, antibiotic agents with activity against gram-negative organisms, such as third-generation cephalosporins, fluoroquinolones, and piperacillin, are usually required. Penicillin and clindamycin, which are often called the standard antibiotic agents for aspiration pneumonia, are inadequate for most patients with aspiration pneumonia. Antibiotic agents with specific anaerobic activity are not routinely warranted and may be indicated only in patients with severe periodontal disease, putrid sputum, or evidence of necrotizing pneumonia or lung abscess on radiographs of the chest.
Decision Making to Initiate Antibiotics for Aspiration Pneumonia Using Procalcitonin
This is a 1-year retrospective and ongoing prospective observational study including a total of 56 patients with aspiration pneumonia admitted to our emergency department (ED) and with PCT(B-R-A-M-SPCT-Q®) measured on admission. A patient with aspiration pneumonia was defined a priori to have risk factors for oropharyngeal aspiration and evidence of radiographical infiltrates suspected aspiration. All cases were classified into low PCT group or high PCT group by a PCT cut-off level of 0.5mcg/L. Medical records were reviewed for PCT levels, laboratory data, physical examination, microbiological data, and antibiotics use.
Overall, 58% (33/56) of patients with aspiration pneumonia were categorized to low PCT group, and 33% of which (11/33) resolved within 48 hours without using antibiotics. The remaining 66% of patients (22/33) survived being administered broad-spectrum antibiotics mostly with anaerobic coverage. 6% (2/33) of low PCT group showed positive sputum culture, while 30% of (7/23) high PCT group. 14% (2/14) out of all patients administered antibiotics had positive sputum culture, while 16% (7/42) not administered antibiotics. None of all the patients had bacteremia. Mean CURB-65 score in low PCT group was 1.42, and that of high PCT group was 2.4 (p<0.05).
Initial PCT level may be of use for prediction of the burden due to virulent bacteria. The low PCT level can discourage us to initiate antibiotics therapy and has the potential to reduce the usage of antibiotics for aspiration pneumonia in ED.