Initial management of aspiration pneumonia

Most cases of pneumonia develop due to aspiration of bacteria from the oropharynx; this is true of all pneumonia, not just aspiration pneumoniaSimpson, 2023.

Empirical therapy in these guidelines for community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) treats most pathogens aspirated from the oropharynx, including oral anaerobes. Therefore, initial management of suspected aspiration pneumonia should follow empirical therapy for CAP or HAP. The need to treat more anaerobic organisms in patients with suspected aspiration pneumonia has been overestimatedBai, 2024Mandell, 2019.

For patients who have had an aspiration event, try to exclude aspiration pneumonitis before starting antibiotic therapy for pneumonia – see Management of a patient who has had an aspiration event for management of patients who have had an aspiration event.

For initial management of aspiration pneumonia in patients from the community, or patients who have been in hospital for less than 48 hours, see:

• Community-acquired pneumonia (CAP) in adults; however, empirical therapy (eg doxycycline, azithromycin, clarithromycin) used for its activity against atypical pathogens (eg Mycoplasma pneumoniae, Chlamydophila [Chlamydia] pneumoniae, Legionella species) is only required for aspiration pneumonia in adults if the patient has high-severity CAPSimpson, 2023Neill, 2019.
• Community-acquired pneumonia (CAP) in residents of an aged-care facility.
• Community-acquired pneumonia (CAP) in children 2 months or older.

For initial management of aspiration pneumonia in a patient who has been either hospitalised in acute care for longer than 48 hours or discharged within the previous 7 days from a hospital admission of longer than 48 hours, see Hospital-acquired pneumonia.

Review patients within 24 to 48 hours of starting antibiotic therapy. Consider stopping antibiotic therapy if aspiration pneumonitis is a more likely diagnosis based on the results of investigations or the speed of recovery (symptoms of aspiration pneumonitis usually improve within 24 to 48 hours).

If the response to initial empirical therapy is inadequate at 48 hours, see Management of aspiration pneumonia in patients who are not improving on empirical therapy for CAP or HAP.