Antibiotic selection for patients with community-acquired aspiration pneumonia

For patients with a clinical picture that is strongly suggestive of aspiration pneumonia acquired in a community setting, we select an antibiotic regimen that covers most pathogenic oral flora, including anaerobic bacteria. When suspicion for aspiration is not strong, we generally treat with standard regimens for CAP because available studies suggest aerobic pathogens predominate and standard coverage is sufficient. This approach is slightly different from the Infectious Diseases Society of America (IDSA) guidelines, which do not routinely add coverage for anaerobes in the absence of lung abscess or empyema. Refer to UpToDate content on the treatment of aspiration pneumonia and CAP for details.

CAP: community-acquired pneumonia; ER: extended release; ICU: intensive care unit; IV: intravenous.

* Dose adjustments may be needed in patients with impaired kidney function.

¶ For severely ill patients, coverage is broadened in those with risk factors for Pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA), or other drug-resistant pathogens.

Strong risk factors for Pseudomonas include known colonization or prior infection, detection of Gram-negative rods on a good-quality sputum stain, and hospitalization with receipt of IV antibiotics in the prior 3 months. Refer to UpToDate content for other factors that might raise suspicion for Pseudomonas infection.
Strong risk factors for MRSA include known colonization or prior infection and detection of Gram-positive cocci in clusters on a good-quality sputum Gram stain. Refer to UpToDate content for other factors that might raise suspicion for MRSA infection.

Δ If not severely ill but have risk factors for Pseudomonas or MRSA, await results of diagnostic testing to guide need for broadening coverage.

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Antibiotic selection for patients with community-acquired aspiration pneumonia

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