What is the treatment for aspiration pneumonitis (inflammation of the lungs due to aspiration)?

From the Guidelines

Aspiration pneumonitis treatment should focus on supportive care, with antibiotics considered only if bacterial pneumonia is suspected, and the choice of antibiotic should be based on the patient's location and suspected causative pathogens, as recommended by guidelines 1. The initial management of aspiration pneumonitis includes maintaining adequate oxygenation through supplemental oxygen or mechanical ventilation if respiratory failure occurs.

• Positioning the patient with the head of bed elevated at 30-45 degrees helps prevent further aspiration.
• Antibiotics are not routinely recommended for pure aspiration pneumonitis since it's a chemical injury, not an infection, but they may be considered if bacterial pneumonia is suspected (typically after 48 hours).
• The choice of antibiotic should be based on the patient's location, with options including:
  • Oral or i.v. b-lactam/b-lactamase inhibitor or Clindamycin for patients admitted from home to a hospital ward 1.
  • Clindamycin + cephalosporin or Cephalosporin + metronidazole or i.v. cephalosporin + oral metronidazole or moxifloxacin for patients in the ICU or admitted from a nursing home 1.
• Bronchoscopy may be necessary to clear large particulate matter or assess airway damage in severe cases.
• Corticosteroids are controversial and not routinely recommended.
• Preventive measures for at-risk patients include nil-by-mouth status before procedures, proper positioning, careful feeding techniques for dysphagic patients, and prokinetic agents like metoclopramide 10mg IV/PO before meals for those with gastroparesis. The distinction between aspiration pneumonitis (chemical injury from gastric contents) and aspiration pneumonia (subsequent bacterial infection) is important for guiding appropriate treatment decisions, as noted in guidelines 1.

From the FDA Drug Label

7 Respiratory Diseases ... Aspiration pneumonitis Methylprednisolone is indicated for the treatment of aspiration pneumonitis.

• The use of methylprednisolone for aspiration pneumonitis is listed under Respiratory Diseases.
• Methylprednisolone may be used as part of the treatment for aspiration pneumonitis 2.

From the Research

Aspiration Pneumonitis Treatment

• Aspiration pneumonitis should be treated by aggressive pulmonary care to enhance lung volume and clear secretions 3
• Intubation should be used selectively in the treatment of aspiration pneumonitis 3
• Early corticosteroids and prophylactic antibiotics are not indicated in the treatment of aspiration pneumonitis 3
• Aspiration pneumonia, on the other hand, requires diligent surveillance for the clinical signs of pneumonia and treatment decisions are based on clinical diagnostic certainty, time of onset, and host factors 3

Antibiotic Treatment

• There is no ideal antibiotic regimen for aspiration pneumonia, and unit-specific resistance patterns and known frequency pathogens should direct broad spectrum empiric therapy 3
• Antibiotic coverage should be narrowed once sputum culture results become available 3
• Aminopenicillins/beta-lactamase inhibitors, newer fluoroquinolones with anaerobic activity (moxifloxacin), and clindamycin have demonstrated equal clinical efficacy in the treatment of aspiration pneumonia and primary lung abscess 4
• Penicillin G is the preferred agent for pulmonary infections involving anaerobic bacteria, but clindamycin is a suitable alternative for patients in whom penicillin G is contraindicated 5

Prevention and Management

• Recognizing the factors that predispose patients to aspiration and identifying the patients who are susceptible to aspiration are the first steps in preventing aspiration pneumonitis 6
• Mechanical ventilatory support, bronchoscopy when indicated, and aggressive fluid management are essential when aspiration does occur 6
• Techniques to avoid or reduce aspiration, such as the semi-recumbent position, surveillance of enteral feeding, use of promotility agents, and avoiding excessive sedation, are important in preventing pneumonia and pneumonitis 7