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Query: UMLS:C0032290 (aspiration pneumonia)
 2,291 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Suppurative complications to aspiration pneumonia occur if the initial aspiration and subsequent pneumonitis go unrecognized or untreated. Anaerobic cavitary disease is typically an indolent process, whereas necrotizing pneumonia is more fulminant and deadly. Rarely are aggressive diagnostic measures necessary in the community-acquired setting. Most patients, even with necrotizing pneumonia, respond well to high-dose penicillin and show clinical improvement within a week to 10 days. Clindamycin may be preferred in cases of severe underlying disease or when penicillin fails to yield signs of recovery. The presence of empyema not only increases the duration of therapy but also is fraught with complications and carries a higher mortality rate (20 vs 5 per cent). Necrotizing pneumonia and pulmonary abscess that develop in the nursing home or hospital setting require a more aggressive diagnostic approach, and broad-spectrum antibiotic coverage is necessary. In spite of these measures and appropriate antibiotic selection, nosocomial-acquired disease carries a mortality rate of 30 to 50 per cent. Surgical intervention, once the mainstay of therapy, is now reserved for patients with complications such as massive hemoptysis, failure to respond to chest tube thoracostomy in the presence of empyema, abscess drainage that fails with postural drainage, and diagnosis of carcinoma.
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PMID:Aspiration pneumonia, necrotizing pneumonia, and lung abscess. 265 1

The majority of lower respiratory tract infections (LRTI) are treated "blindly" because the establishment of an aetiological diagnosis is not possible in most cases. The rational choice of therapy mainly rests upon the knowledge of the microbiological epidemiology of LRTI, and on the possible host-parasite relationship. In community-acquired pneumonia, there is general concensus that penicillin maintains its position as the first drug of choice, and that therapy can be changed to erythromycin or tetracycline in cases of therapeutic failure. Treatment of nosocomial pneumonia, and LRTI in immunocompromised patients, calls for antibiotics with a broader antimicrobial spectrum. Clindamycin has an antimicrobial spectrum which makes this antibiotic a possible alternative in community-acquired pneumonia, and its efficacy in pneumococcal pneumonia has been documented. However, as first choice therapy it should be reserved for cases of penicillin allergy, or cases of strongly suspected staphylococcal pneumonia. In aspiration pneumonia--nearly always caused by anaerobic bacteria--penicillin has long been the preferred therapy, even in cases with Bacteroides fragilis. However, recent publications have clearly documented that in primary lung abscess, clindamycin is superior to penicillin. These results are especially important since metronidazole has been shown to be less effective in such cases.
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PMID:Use of clindamycin in lower respiratory tract infections. 659 21

Gastroesophageal reflux disease (GERD) has many protean manifestations. Some of the most vexing have to do with the airway. GERD affects the tracheobronchial tree directly, leading to aspiration pneumonia and asthma, or exacerbating existing pulmonary disease, such as asthma or chronic obstructive pulmonary disease. In addition to the respiratory manifestation of GERD, there are unique pharyngeal and laryngeal manifestations. These include voice hoarseness, throat-clearing, chronic cough, globus, and "post-nasal drip". Linking these symptoms to GERD is challenging and frequently the diagnosis is that of exclusion. Despite proton pump inhibitor therapy being the mainstay of treatment, with anti-reflux surgery being reserved for intractable cases, there is no definitive evidence of the superiority of either.
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PMID:Gastroesophageal reflux disease and the airway-essentials for the surgeon. 2116 Jul 88