Pharmacologic prevention of aspiration pneumonia: a systematic review.
BACKGROUND
Aspiration pneumonia is a common cause of morbidity and mortality. Several approaches, including bed positioning, dietary changes, and oral hygiene, have been proposed to prevent aspiration pneumonia, yet few data are available on the efficacy of pharmacologic interventions in reducing the rate of aspiration.


OBJECTIVE
This study was a systematic literature review of the pharmacologic prevention of aspiration pneumonia.


METHODS
We searched MEDLINE (1996-2006); EMBASE (1974-2006); Cumulative Index to Nursing & Allied Health Literature (CINAHL) (1982-2006); Health Services Technology, Administration, and Research (HealthSTAR) (1975-2006); and the Cochrane Library for relevant articles. References of all included articles were reviewed. Studies were included if they had a prospective, controlled design with a primary outcome of prevention of aspiration pneumonia. Surrogate outcomes that had a direct link to decreasing the incidence of aspiration pneumonia were considered. Selected articles were reviewed independently by 2 authors.


RESULTS
Of 1108 studies reviewed, 20 were analyzed. Angiotensin-converting enzyme inhibitors may be beneficial in selected patients at high risk for aspiration. Capsaicin may be a low-risk approach to stimulate swallowing and cough reflexes. Amantadine, cabergoline, and theophylline may cause serious adverse events, and their routine use for prevention of aspiration pneumonia is not recommended. Cilostazol should not be used because of the increased risk for bleeding.


CONCLUSIONS
Limited information is available on benefits and risks to guide an evidence-based approach to the pharmacologic prevention of aspiration pneumonia. Considering the high incidence of aspiration pneumonia in older adults, large randomized clinical trials on the effectiveness of pharmacologic interventions are warranted.
El Solh
Ali A
AA
Westem New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Erie County Medical Center, Buffalo, New York 14215, USA. solh@buffalo.edu
Saliba
Ranime
R
D000368:Aged; D000547:Amantadine / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000077465:Cabergoline; D002211:Capsaicin / Q000627:therapeutic use; D000077407:Cilostazol; D018849:Controlled Clinical Trials as Topic; D004873:Ergolines / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D012307:Risk Factors; D018689:Sensory System Agents / Q000627:therapeutic use; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use; D013806:Theophylline / Q000009:adverse effects / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D004873:Ergolines; D018689:Sensory System Agents; D013777:Tetrazoles; D000547:Amantadine; D013806:Theophylline; D000077465:Cabergoline; D000077407:Cilostazol; D002211:Capsaicin