Oral or enteral antibiotic therapy for aspiration pneumonia in patients who are not improving on empirical therapy for CAP

To determine whether the below regimens are appropriate for a patient with aspiration pneumonia who has not improved on the empirical regimen for CAP, see Management of aspiration pneumonia in patients who are not improving on empirical therapy for CAP or HAP. If appropriate, add to the empirical regimen for CAP:

metronidazole 400 mg (child: 10 mg/kg up to 400 mg) orally or enterally, 12-hourly. See advice on duration of therapy. metronidazole metronidazole metronidazole

Alternatively, if a single-drug regimen is preferred (eg to reduce toxicity or improve adherence), replace the empirical regimen for CAP with:

amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally or enterally, 12-hourly¹. For dosage adjustment in adults with kidney impairment, see amoxicillin+clavulanate oral dosage adjustment. See advice on duration of therapy. amoxicillin + clavulanate amoxicillin+clavulanate amoxicillin+clavulanate

For patients with penicillin hypersensitivity, as a single-drug regimen, use:

1clindamycin 450 mg (child: 10 mg/kg up to 450 mg) orally or enterally, 8-hourly². See advice on duration of therapy clindamycin clindamycin clindamycin

2moxifloxacin 400 mg (child: 10 mg/kg up to 400 mg) orally or enterally, daily. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. See advice on duration of therapy ³ ⁴. moxifloxacin moxifloxacin moxifloxacin

¹ Amoxicillin+clavulanate may be suitable for children aged 1 month to younger than 2 months but a different dosage is required.Return

² An oral liquid formulation of clindamycin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return

³ Moxifloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Moxifloxacin can be used in children when it is the drug of choice.Return

⁴ An oral liquid formulation of moxifloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return