Comparison of non-pharmacological strategies and antibiotic prophylaxis for the prevention of aspiration pneumonia in geriatric dysphagia
Keywords:
Aspiration pneumonia, Older adults, Non-pharmacological strategies, Antibiotic prophylaxis, Patient safetyAbstract
Introduction: Aspiration pneumonia is a leading cause of morbidity and mortality in older adults with dysphagia, generating a high healthcare burden. There is controversy regarding the optimal preventive strategy.
Objective: To compare the effectiveness, safety, and applicability of non-pharmacological interventions versus antibiotic prophylaxis for preventing aspiration pneumonia in this population.
Methodology: A systematic review (PRISMA) was conducted in PubMed, Scopus, and SciELO (2018-2025). PICOS criteria were used, and risk of bias was assessed using the ROB-2, AMSTAR-2, and Newcastle-Ottawa tools. The certainty of the evidence was graded using GRADE.
Results: Of 432 records identified, 26 studies were included. The evidence demonstrated a clear superiority of non-pharmacological strategies (IDDSI dietary adaptation, oral hygiene, swallowing rehabilitation) in reducing episodes of pneumonia, with an optimal safety profile. Antibiotic prophylaxis showed no significant benefits and was associated with risks such as bacterial resistance and C. difficile infection.
Conclusions: Non-pharmacological interventions are the cornerstone of prevention. Antibiotic prophylaxis should be restricted to exceptional high-risk cases and for a limited time, within a multidisciplinary approach.
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