epocrates logo
epocrates logo
epocrates logo
  • 0

Diseases

Aspiration pneumonia

OVERVIEW

  • Highlights & Basics
  • Images

DIAGNOSIS

  • Diagnostic Approach
  • Risk Factors
  • History & Exam
  • Tests
  • Differential Diagnosis
  • Criteria
  • Screening

TREATMENT

  • Tx Approach
  • Tx Options
  • Emerging Tx
  • Prevention

FOLLOW-UP

  • Overview
  • Complications

REFERENCES

  • Citations
  • Guidelines
  • Credits

PATIENT RESOURCES

  • Patient Instructions

Highlights & Basics

AAFont SizeShareMore Information
Key Highlights
  • Aspiration pneumonia is diagnosed based on clinical signs or symptoms of pneumonia in a person with a history or risk factors for aspiration.

  • Sputum or tracheal Gram stain reveals mixed flora.

  • Infection usually involves the dependent lung lobe.

  • Complications of disease include lung abscess and empyema.

Quick Reference

  • History & Exam

    • Key Factors

      • Other Factors

        More information...
      • Diagnostics Tests

          More information...
        • Treatment Options

            More information...

          Definition

          Epidemiology

          Etiology

          Pathophysiology

          content by BMJ Group
          Last updated

          Images

          • Early ill-defined opacities of the right upper lobe above the minor fissure consistent with early ch

            Early ill-defined opacities of the right upper lobe above the minor fissure consistent with early changes of aspiration pneumonia

          • Increased opacification of the right perihilar region and superior segment of the right lower and up

            Increased opacification of the right perihilar region and superior segment of the right lower and upper lobes consistent with worsening aspiration pneumonia

          Citations

            Key Articles

            • Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67.[Abstract][Full Text]

            • American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017 Mar;126(3):376-93.[Abstract][Full Text]

            • Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.[Abstract][Full Text]

            Referenced Articles

            • 1. Bartlett JG, Gorbach SL, Finegold SM. The bacteriology of aspiration pneumonia. Am J Med. 1974;56:202-207.[Abstract]

            • 2. El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003;167:1650-1654.[Abstract][Full Text]

            • 3. Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med. 2011;17:148-154.[Abstract]

            • 4. Lanspa MJ, Peyrani P, Wiemken T, et al. Characteristics associated with clinician diagnosis of aspiration pneumonia: a descriptive study of afflicted patients and their outcomes. J Hosp Med. 2015;10:90-96.[Abstract][Full Text]

            • 5. Taylor JK, Fleming GB, Singanayagam A, et al. Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort. Am J Med. 2013;126:995-1001.[Abstract]

            • 6. Mandell LA, Niederman MS. Aspiration pneumonia. N Engl J Med. 2019 Feb 14;380(7):651-663.[Abstract]

            • 7. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67.[Abstract][Full Text]

            • 8. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71.[Abstract]

            • 9. Huxley EJ, Viroslav J, Gary WR, et al. Pharyngeal aspiration in normal adults and patients with depressed consciousness. Am J Med. 1978;64:564-568.[Abstract]

            • 10. Lanspa MJ, Jones BE, Brown SM, et al. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. 2013;8:83-90.[Abstract][Full Text]

            • 11. Lindenauer PK, Strait KM, Grady JN, et al. Variation in the diagnosis of aspiration pneumonia and association with hospital pneumonia outcomes. Ann Am Thorac Soc. 2018 May;15(5):562-9.[Abstract][Full Text]

            • 12. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003 Jul;124(1):328-36.[Abstract]

            • 13. Johnson JL, Hirsch CS. Aspiration pneumonia. Postgrad Med. 2003;113:99-102,105-106,111-112.[Abstract]

            • 14. Tokuyasu H, Harada T, Watanabe E, et al. Effectiveness of meropenem for the treatment of aspiration pneumonia in elderly patients. Intern Med. 2009;48:129-135.[Abstract][Full Text]

            • 15. Takayanagi N, Kagiyama N, Ishiguro T, et al. Etiology and outcome of community-acquired lung abscess. Respiration. 2010;80:98-105.[Abstract]

            • 16. Dickson RP, Erb-Downward JR, Huffnagle GB. Homeostasis and its disruption in the lung microbiome. Am J Physiol Lung Cell Mol Physiol. 2015;309:L1047-L1055.[Abstract][Full Text]

            • 17. Purkey MT, Levine MS, Prendes B, et al. Predictors of aspiration pneumonia following radiotherapy for head and neck cancer. Ann Otol Rhinol Laryngol. 2009;118:811-816.[Abstract]

            • 18. Manabe T, Teramoto S, Tamiya N, et al. Risk factors for aspiration pneumonia in older adults. PLoS One. 2015;10:e0140060.[Abstract][Full Text]

            • 19. American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017 Mar;126(3):376-93.[Abstract][Full Text]

            • 20. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-e111.[Abstract][Full Text]

            • 21. Pace CC, McCullough GH. The association between oral microorganisms and aspiration pneumonia in the institutionalized elderly: review and recommendations. Dysphagia. 2010;25:307-322.[Abstract]

            • 22. Torres A, Serra-Batlles J, Ros E, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992;116:540-543.[Abstract]

            • 23. Orozco-Levi M, Torres A, Ferrer M, et al. Semirecumbent position protects from pulmonary aspiration but not completely from gastroesophageal reflux in mechanically ventilated patients. Am J Respir Crit Care Med. 1995;152:1387-1390.[Abstract]

            • 24. Sarin J, Balasubramaniam R, Corcoran AM, et al. Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health preventions. J Am Med Dir Assoc. 2008;9:128-135.[Abstract]

            • 25. Mylotte JM. Will maintenance of oral hygiene in nursing home residents prevent pneumonia? J Am Geriatr Soc. 2018 Mar;66(3):590-594.[Abstract]

            • 26. Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50:430-433.[Abstract]

            • 27. Sjögren P, Nilsson E, Forsell M, et al. A systematic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. J Am Geriatr Soc. 2008;56:2124-2130.[Abstract]

            • 28. Scannapieco FA. Pneumonia in nonambulatory patients: the role of oral bacteria and oral hygiene. J Am Dent Assoc. 2006;137(suppl 2):21S-25S.[Abstract]

            • 29. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, et al. Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology. 2013;30:3-9.[Abstract]

            • 30. Tada A, Miura H. Prevention of aspiration pneumonia (AP) with oral care. Arch Gerontol Geriatr. 2012;55:16-21.[Abstract]

            • 31. Sjögren P, Wårdh I, Zimmerman M, et al. Oral care and mortality in older adults with pneumonia in hospitals or nursing homes: systematic review and meta-analysis. J Am Geriatr Soc. 2016;64:2109-2115.[Abstract]

            • 32. Alkhawaja S, Martin C, Butler RJ, et al. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev. 2015;(8):CD008875.[Abstract][Full Text]

            • 33. Horiuchi A, Nakayama Y, Sakai R, et al. Elemental diets may reduce the risk of aspiration pneumonia in bedridden gastrostomy-fed patients. Am J Gastroenterol. 2013;108:804-810.[Abstract][Full Text]

            • 34. Takatori K, Yoshida R, Horai A, et al. Therapeutic effects of mosapride citrate and lansoprazole for prevention of aspiration pneumonia in patients receiving gastrostomy feeding. J Gastroenterol. 2013 Oct;48(10):1105-10.[Abstract]

            • 35. El Solh AA, Saliba R. Pharmacologic prevention of aspiration pneumonia: a systematic review. Am J Geriatr Pharmacother. 2007;5:352-362.[Abstract]

            • 36. Brady M, Kinn S, Ness V, et al. Preoperative fasting for preventing perioperative complications in children. Cochrane Database Syst Rev. 2009;(4):CD005285.[Abstract][Full Text]

            • 37. Puig I, Calzado S, Suárez D, et al. Meta-analysis: comparative efficacy of H2-receptor antagonists and proton pump inhibitors for reducing aspiration risk during anaesthesia depending on the administration route and schedule. Pharmacol Res. 2012;65:480-490.[Abstract]

            • 38. Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011;183:310-319.[Abstract][Full Text]

            • 39. Paranjothy S, Griffiths JD, Broughton HK, et al. Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database Syst Rev. 2014;(2):CD004943.[Abstract][Full Text]

            • 40. Niederman MS. Imaging for the management of community-acquired pneumonia: what to do if the chest radiograph Is clear. Chest. 2018 Mar;153(3):583-5.[Abstract][Full Text]

            • 41. Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department or inpatient settings: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021 Jul;174(7):985-93.[Abstract][Full Text]

            • 42. Brodsky MB, Suiter DM, González-Fernández M, et al. Screening accuracy for aspiration using bedside water swallow tests: a systematic review and meta-analysis. Chest. 2016;150:148-163.[Abstract]

            • 43. Australian and New Zealand Society for Geriatric Medicine position statement abstract: dysphagia and aspiration in older people. Australas J Ageing. 2020 Mar;39(1):85.

            • 44. Kishore AK, Jeans AR, Garau J, et al. Antibiotic treatment for pneumonia complicating stroke: Recommendations from the pneumonia in stroke consensus (PISCES) group. Eur Stroke J. 2019 Dec;4(4):318-328.[Abstract][Full Text]

            • 45. Daoud E, Guzman J. Q: Are antibiotics indicated for the treatment of aspiration pneumonia? Cleve Clin J Med. 2010;77:573-576.[Abstract]

            • 46. Shinohara Y, Origasa H. Post-stroke pneumonia prevention by angiotensin-converting enzyme inhibitors: results of a meta-analysis of five studies in Asians. Adv Ther. 2012;29:900-912.[Abstract]

            • 47. Caldeira D, Alarcão J, Vaz-Carneiro A, et al. Risk of pneumonia associated with use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers: systematic review and meta-analysis. BMJ. 2012 Jul 11;345:e4260.[Abstract][Full Text]

            • 48. Tsunoda H, Okami Y, Honda Y, et al. Effectiveness of angiotensin converting enzyme inhibitors in preventing pneumonia: A systematic review and meta-analysis. J Gen Fam Med. 2022 Jul;23(4):217-27.[Abstract][Full Text]

            • 49. Yamaya M, Yanai M, Ohrui T, et al. Antithrombotic therapy for prevention of pneumonia. J Am Geriatr Soc. 2001;49:687-688.[Abstract]

            • 50. Osawa A, Maeshima S, Tanahashi N. Efficacy of cilostazol in preventing aspiration pneumonia in acute cerebral infarction. J Stroke Cerebrovasc Dis. 2013;22:857-861.[Abstract]

            • 51. Ebihara S, Kohzuki M, Sumi Y, et al. Sensory stimulation to improve swallowing reflex and prevent aspiration pneumonia in elderly dysphagic people. J Pharmacol Sci. 2011;115:99-104.[Abstract][Full Text]

            • 52. Nakagawa T, Wada H, Sekizawa K, et al. Amantadine and pneumonia. Lancet. 1999 Apr 3;353(9159):1157.[Abstract]

            • 53. Arai T, Sekizawa K, Yoshimi N, et al. Cabergoline and silent aspiration in elderly patients with stroke. J Am Geriatr Soc. 2003 Dec;51(12):1815-6.[Abstract][Full Text]

            • 54. Ebihara T, Ebihara S, Okazaki T, et al. Theophylline-improved swallowing reflex in elderly nursing home patients. J Am Geriatr Soc. 2004 Oct;52(10):1787-8.[Abstract][Full Text]

            • 55. Yamasaki M, Ebihara S, Ebihara T, et al. Effects of capsiate on the triggering of the swallowing reflex in elderly patients with aspiration pneumonia. Geriatr Gerontol Int. 2010 Jan;10(1):107-9.[Abstract][Full Text]

            • 56. Nakashima T, Hattori N, Okimoto M, et al. Nicergoline improves dysphagia by upregulating substance P in the elderly. Medicine (Baltimore). 2011 Jul;90(4):279-83.[Abstract][Full Text]

            • 57. Warusevitane A, Karunatilake D, Sim J, et al. Safety and effect of metoclopramide to prevent pneumonia in patients with stroke fed via nasogastric tubes trial. Stroke. 2015;46:454-460.[Abstract][Full Text]

            • 58. El-Solh AA, Vora H, Knight PR 3rd, et al. Diagnostic use of serum procalcitonin levels in pulmonary aspiration syndromes. Crit Care Med. 2011;39:1251-1256.[Abstract]

          Have feedback?
          Tell us about your experience
          Scroll to Top
          epocrates logo

          Sign in to access our clinical decision support tools

          Sign inCreate Account
          Download Epocrates from the App StoreDownload Epocrates from the Play Store
          About UsFeaturesBusiness SolutionsHelp & Feedback
          © 2026 epocrates, Inc.   Terms of UsePrivacy PolicyEditorial PolicyDo Not Sell or Share My Information