Modification and duration of therapy for aspiration pneumonia in patients who are not improving on empirical therapy for CAP or HAP

For patients with aspiration pneumonia treated with intravenous antibiotic therapy who are clinically improving, consider switching to oral or enteral therapy (see Guidance for intravenous to oral switch for guidance on when to switch to oral therapy). For regimens, see Oral or enteral antibiotic therapy for aspiration pneumonia in patients who are not improving on empirical therapy for CAP or Oral or enteral antibiotic therapy for aspiration pneumonia in patients who are not improving on empirical therapy for HAP.

The usual duration of therapy (intravenous + oral) for aspiration pneumonia is 5 days. If the patient is not improving, consider complications or seek expert advice.

A longer duration of therapy is required for patients with lung abscess, complicated parapneumonic effusion or empyema complicating pneumonia. Patients with necrotising pneumonia may also require a longer duration of therapy – seek expert adviceMandell, 2019.