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The most frequently isolated bacteria from patients with community-acquired aspiration pneumonia were S. Rigorous sampling was undertaken to identify pathogens, including blood cultures, urinary antigen tests and bronchoscopic methods, with appropriate specimen processing for anaerobic organism detection. Isolates from 11 patients contained anaerobes: eight were penicillin-susceptible (Prevotella, Fusobacterium and Peptostreptococcus) and three penicillin-resistant (Prevotella and Bacteroides).

Despite this, six of these seven showed clinical improvement. The most recent edition of Therapeutic guidelines: antibiotic (published in 2010) suggests the empirical use of benzylpenicillin in combination with metronidazole for treating patients with aspiration pneumonia.

Aside no period cramps the potential side effects of metronidazole, such as abdominal pain, pancreatitis or, more rarely, neurotoxicity,16 indiscriminate use may promote antibiotic-resistant flora.

As most bacteria present in the bowel are anaerobic, the empirical use of specific anti-anaerobic therapy such as metronidazole has the potential to cause significant collateral damage. Animal studies have alluded to an association between anti-anaerobic therapy and the development and persistence of vancomycin-resistant enterococci (VRE) carriage.

Although metronidazole may not be necessary in initial empirical therapy of aspiration pneumonia, there is a need for appropriate treatment where anaerobic bacteria such as Bacteroides are the primary pathogens. This may manifest with the development of abscesses, empyema or necrotising pneumonia, and treatment of these episodes should include specific anti-anaerobic therapy. Omission of metronidazole from empirical treatment for most patients with aspiration pneumonia may be of benefit in this era of increasing antibiotic resistance.

We thank Peter Ward and Janet Montgomery from the Department of Microbiology, Austin Health, for their advice. Publication of your online response is subject to Kenalog Spray (Triamcinolone Acetonide Topical Aerosol)- Multum Medical Journal of Australia's editorial discretion.

You will be notified by email within five working days should your response be accepted. Australian Medical Association Basic Search Advanced Clobetasol Propionate Lotion (Clobex Lotion)- FDA search Use the Advanced search for more specific terms.

Title contains Body contains Date range from Clobetasol Propionate Lotion (Clobex Lotion)- FDA range to Article type Author's surname Volume First page doi: 10. What is aspiration pneumonia. Isolation of anaerobic organisms is difficult, requiring specific sampling, transport and culturing measures. What are the current guidelines for treating aspiration pneumonia.

What is the problem with giving unnecessary metronidazole. Johnson PDR, Irving LB, Turnidge JD. Practice essentials - infectious diseases. Melbourne: Therapeutic Guidelines Limited, 2010. Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009.

Mandell LA, Wunderink RG, Anzueto A, et al. Teramoto S, Fukuchi Y, Sasaki H, et al. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. Aspiration pneumonitis and aspiration pneumonia. Mier L, Dreyfuss D, Darchy B, et al. Is penicillin G an adequate initial treatment for aspiration pneumonia. A prospective evaluation using a Clobetasol Propionate Lotion (Clobex Lotion)- FDA specimen brush and quantitative cultures.

Ebihara S, Ebihara T, Yamanda S, Kohzuki Clobetasol Propionate Lotion (Clobex Lotion)- FDA. Lanspa MJ, Li Y, Brown S, et al. Bartlett JG, Gorbach SL, Finegold SM. The bacteriology of aspiration pneumonia. Lorber B, Swenson RM. Bacteriology of aspiration pneumonia: a prospective study of community- and hospital-acquired cases. Cesar L, Gonzalez CCL, Calia FM. Bacteriologic flora of aspiration-induced pulmonary infections. Bartlett JG, Gorbach SL. Treatment Tikosyn (Dofetilide)- FDA aspiration pneumonia and primary lung abscess: penicillin G vs clindamycin.

El-Solh AA, Pietrantoni C, Bhat A, et al. Microbiology of severe aspiration pneumonia in institutionalized elderly. Marik PE, Careau P.

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