Antibacterial treatment of aspiration pneumonia in older people: a systematic review

Timra J Bowerman,1–3 Jan Zhang,2 Louise M Waite4,5 1Department of Aged Care, Psychogeriatrics and Rehabilitation, Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia; 2Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia; 3University of New South Wales, Sydney, NSW, Australia; 4Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, NSW, Australia; 5University of Sydney, Sydney, NSW, Australia Background: Aspiration pneumonia is a common problem in older people with high mortality and increasing prevalence.Objective: The aims of this paper were to systematically review the literature on the antibacterial treatment of aspiration pneumonia in elderly patients and identify the microbiology of aspiration pneumonia.Materials and methods: EMBASE, MEDLINE, and Cochrane databases were systematically searched for studies that examined the clinical efficacy of antibiotic treatment in elderly patients with aspiration pneumonia. Information on study design, antibiotic treatment, study population, participants, microbiology, clinical outcomes, adverse events, and mortality was recorded.Results: There were no definitive clinical trials, placebo-controlled trials, or meta-analyses. Of the eight studies selected for inclusion in the review, the majority utilized and/or compared broad-spectrum antibiotics. No specific antibacterial agent had evidence of superior efficacy. Broad-spectrum antibiotics resulted in the emergence of multiresistant organisms. Anaerobic bacteria were infrequently isolated, suggesting a less important role in the pathogenesis of aspiration pneumonia.Conclusion: There is limited evidence with regard to the use of antibiotics in older patients with aspiration pneumonia. Research providing an evidence base for the treatment of aspiration pneumonia in older people is required. Keywords: aspiration pneumonia, antibiotics, antibacterial, antimicrobial, older peopl