Aspiration Pneumonia Symptoms, Causes & Treatment Options

Aspiration pneumonia is a bacterial infection of the airspaces in the lung where the source of bacteria comes from inhaling bacteria that colonizes the mouth or gut. This type of pneumonia needs special antibiotic treatment.

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Aspiration Pneumonia?


Aspiration pneumonia is a specific kind of pneumonia that occurs in people with difficulty swallowing, consciousness impairment, alcoholism, or less commonly, simply “swallowed food down the wrong pipe.” “Pneumonia” is the infection of the air sacs of the lung, which are called alveoli. “Aspiration” pneumonia means that the bacteria comes from accidentally inhaling the contents of the stomach. This kind of pneumonia differs from other kinds of pneumonia because the organisms that live in the stomach contacts are different from the organisms the lungs typically get exposed to. This means that antibiotic choice needs to be specific for aspiration pneumonia. When treated appropriately, aspiration pneumonia typically completely resolves, however, the infection can become severe and lead to bloodstream infection if it goes untreated.

Recommended care

Aspiration Pneumonia Symptoms

Main symptoms

The typical symptoms for aspiration pneumonia are similar to those of ordinary pneumonia.

  • Trouble catching your breath: This occurs because it is harder to oxygenate your blood with bacteria in the way. The body responds by increasing your drive to breathe.
  • Fever
  • Cough
  • Coughing up blood
  • Coughing up sputum: This sputum can be especially foul-smelling.
  • Chest pain: This pain is usually localized to a small region on one side of your chest. You may not have pain at all.

Other symptoms

The following symptoms may also occur.

  • Wheezing
  • Bad breath
  • Difficulty swallowing
  • Fast heartbeat
  • Blue discoloration of skin

Complications of aspiration pneumonia

The following can occur if the pneumonia goes untreated.

  • Abscess: formation of a pocket of pus in the lung that is difficult to treat with antibiotics
  • Empyema: leakage of fluid into the space around the lung. The bacteria from the pneumonia then grow in this fluid and can lead to lung collapse.
  • Sepsis: leakage of bacteria into the bloodstream. Sepsis is serious and can lead to death if it is not promptly treated.
  • Irreversible death of lung tissue: The pneumonia can become “necrotizing,” which means that it kills the surrounding tissue.
  • Respiratory failure: You may be unable to adequately ventilate or oxygenate your blood, requiring external support.
  • Kidney injury
  • Death

Aspiration Pneumonia Causes

The cause of any pneumonia is the introduction of bacteria, viruses, or fungi into the lower respiratory tract (the lungs). These organisms take residence in the alveoli, which are tiny little balloons that fill with air when you breathe. The bacteria grow and prevent the lungs from doing their job because they stop air from crossing into your blood, which means that you can develop problems oxygenating your blood. In the case of aspiration pneumonia, the organisms are bacteria, and it specifically gets into your lungs because of accidental inhalation of stomach contents. You can simply swallow food or drink “into the wrong pipe” or you may be predisposed to aspiration. There are specific reasons someone may aspirate, which are detailed below.

Culprit organisms

The following organisms are usually the cause of aspiration pneumonia:

  • Peptostreptococcus
  • Fusobacterium
  • Bacteroides
  • Prevotella

Risk factors for aspiration

The following features make it more likely that you aspirate your stomach contents:

  • Any impairment or loss of consciousness
  • Alcoholism
  • Seizure
  • Stroke
  • Dementia
  • Difficulty swallowing
  • History of radiation treatment
  • Chronic heartburn or GERD
  • Dental issues

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Treatment Options, Relief, and Prevention for Aspiration Pneumonia


Diagnosing aspiration pneumonia can be tricky. Not only does a diagnosis of pneumonia have to be made, which is sometimes challenging, but also the provider has to have a high suspicion that an aspiration event took place. This is why it is important to always tell your provider about all of your medical history, including all the medications you take.

Some diagnostic tests may include:

  • Chest x-ray
  • CT scan of the chest: This test provides much more radiation than a chest x-ray but is much more accurate.
  • Culture of your coughed-up sputum
  • Blood count, blood gas, and culture
  • Bronchoscopy: This involves the insertion of a camera into your airway while you are asleep. The doctor can then sample areas of infection
  • Swallow study

Some pneumonias can be treated outside of the hospital, and some need to be treated in the hospital. The provider will make the decision how you are to be treated. The treatment of aspiration pneumonia is centered around antibiotics. The following antibiotics are typical:

  • Ampicillin-sulbactam (Unasyn): intravenous antibiotic for severe cases
  • Amoxicillin-clavulanate (Augmentin): oral antibiotic for less severe cases
  • Metronidazole (Flagyl)
  • Clindamycin
  • Ceftriaxone (Rocephin)
  • Cefotaxime

Other treatments include supporting your breathing, which typically includes supplemental oxygen through a tube that sits in the front of your nose. However, if the doctors cannot get good blood oxygenation, they will escalate the delivery method of the oxygen. In severe cases, you may need to be intubated, which means receiving a breathing tube into your windpipe.

You may also get some medication to decrease your fever, such as acetaminophen (Tylenol).

Pneumonia always requires monitoring to prove that it has resolved. In the hospital, you will typically receive repeated x-rays to monitor the progress. Outside the hospital, you will receive a follow-up chest x-ray to ensure resolution.


Prevention of aspiration pneumonia centers around risk factor control. If you or your doctor has any suspicion that you cannot swallow normally, you should undergo a swallow study. This study will determine if it is safe for you to swallow. If it is unsafe, then you have a high aspiration risk. If you have a high aspiration risk, then it may be appropriate for you to receive your nutrition through a tube instead of by chewing and swallowing it. For those with swallowing impairment, raising the head of the bed 30 degrees may help.

Avoiding anything that impairs your consciousness such as the use of opiates, alcohol, and benzodiazepines decreasing your chance of aspirating.

All people should strive for adequate oral hygiene to decrease the presence of pathologic bacteria in the mouth.

When to Seek Further Consultation for Aspiration Pneumonia

Seek further consultation if you have difficulty catching your breath (shortness of breath) and have a fever above 38 ºC or 100.4ºF. If your doctor cannot see you in the office same-day, then it is appropriate to go to an urgent care facility or emergency room. Prompt treatment of pneumonia prevents progression into something much more serious.

If you have a history of swallowing impairment, alcoholism, or chronic heartburn, it is important that you let your provider know.