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Aspiration Pneumonia

Empiric treatment of aspiration pneumonia is divided into hospital-acquired and community-acquired disease.

Hospital-acquired

Mild or moderate disease

amoxicillin+clavulanic acid

HMLSchedNZFPMLnoids

PO 500 mg/125 mg three times a day

(or IV 1 g/200 mg every eight hours)

Mild penicillin allergy

cefuroxime

HMLSchedNZFPMLnoids

PO 500 mg twice a day

(or IV 1.5 g every eight hours)

Severe penicillin allergy

clindamycin

HMLSchedNZFPMLnoids

PO 450 mg three times a day

(or IV 600 mg every eight hours)

AND EITHER

gentamicin

HMLSchedNZFPMLnoids

See dosing guidelines

OR

ciprofloxacin

HMLSchedNZFPMLnoids

PO 500 mg twice a day

Severe disease

piperacillin+tazobactam

HMLNZFPMLnoids

IV 4 g/500 mg every eight hours

Mild penicillin allergy

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology/Respiratory Medicine.

Community-acquired

Mild or moderate disease

amoxicillin

HMLSchedNZFPMLnoids

PO 1000 mg three times a day

(or IV 1 g  every eight hours)

Penicillin allergy

clindamycin

HMLSchedNZFPMLnoids

PO 450 mg three times a day

(or IV 600 mg every eight hours)

Severe or life-threatening disease

ceftriaxone

HMLSchedNZFPMLnoids

IV 1 g every 24 hours

AND

metronidazole

HMLSchedNZFPMLnoids

PO 600 mg twice a day

(or IV 500 mg every twelve hours if GI absorption is compromised or patient is nil by mouth)

Severe penicillin allergy

Start the following and consult Infectious Diseases/Clinical Microbiology:

clindamycin

HMLSchedNZFPMLnoids

IV 600 mg every eight hours

AND EITHER

gentamicin

HMLSchedNZFPMLnoids

See dosing guidelines

OR

ciprofloxacin

HMLSchedNZFPMLnoids

IV 400 mg every twelve hours

Pathogens Known

See Community-acquired Pneumonia, pathogens known.

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Topic Code: 557687