Do Antibiotics with Extended Anaerobic Coverage Benefit Patients with Aspiration Pneumonia?

Up to 15% of community-acquired pneumonias occur secondarily to aspiration of oropharyngeal or gastric secretions, with an associated mortality of about 30%. Extended anaerobic coverage with aminopenicillin/beta-lactamase–inhibitor combinations (or moxifloxacin, or metronidazole or clindamycin with cephalosporins) has long been standard of care. However, smaller studies recently have questioned the need for regimens with extended anaerobic spectra. Now, researchers have conducted a retrospective cohort study involving almost 4000 patients with aspiration pneumonia treated in 18 Canadian hospitals between 2015 and 2022. Median treatment duration was 5 days for limited anaerobic coverage (LAC; monotherapy with ceftriaxone, cefotaxime, or levo…