How does a toxic appearance affect the antibiotic selection in the treatment of aspiration pneumonia?

Updated: Aug 15, 2018
  • Author: Justina Gamache, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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For patients without a toxic appearance, the antibiotic chosen should cover typical community-acquired pathogens. Ceftriaxone plus azithromycin, levofloxacin, or moxifloxacin are appropriate choices. [23]  

For patients with a toxic appearance or who were recently hospitalized, although community-acquired pathogens are still the most common, gram-negative bacteria including Pseudomonas aeruginosa and Klebsiella pneumoniae as well as methicillin-resistant S aureus (MRSA) must be covered. Piperacillin/tazobactam or imipenem/cilastatin plus vancomycin would be appropriate. Telavancin is indicated for hospital-acquired pneumonia, including ventilator-associated bacterial pneumonia caused by susceptible isolates of S aureus, including methicillin-susceptible and resistant isolates, when alternative treatments are not suitable. However, the nephrotoxic risk of this antibiotic must be taken into consideration when choosing an appropriate antimicrobial therapy. The presence of chronic aspiration risks, putrid discharge, indolent hospital course, and necrotizing pneumonia should raise the suspicion for anaerobic bacteria involvement and prompt consideration of adding clindamycin or metronidazole to the antibiotic regimen. [24] Ceftaroline is an alternative to vancomycin for the treatment of community-acquired pneumonia due to MRSA.

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