Most people with aspiration do not develop pneumonia; Antibiotics are not required for aspiration pneumonitis.
Patients with adequate respiratory reserve can be monitored off antibiotics.
Fever, crackles, and new chest radiograph (CXR) opacification can be seen in both aspiration pneumonitis and pneumonia.
Piperacillin/tazobactam is not first line therapy for hospital acquired “aspiration” pneumonia and should be reserved for patients at high risk for antibiotic resistant organisms.
Not witnessed, but high risk of aspiration based on history OR predisposing conditions:
Impaired cough and/or gag reflex
2-5 hours before respiratory deterioration
Guideline adapted from Providence Health Care