Dr Joseph raises a very important question, one that we discussed extensively when designing our study. Research in children and adults with pulmonary disease secondary to aspiration of oral contents has repeatedly documented the presence of oral anaerobic bacteria in the pulmonary trees of affected patients.1- 3 These organisms do not exist in the lungs of healthy persons. As a result, systemic antibiotic therapy has become the standard of care for this disease, although, to our knowledge, no placebo-controlled trials have ever been conducted.
Jacobsen SJ, Griffiths K, Diamond S, Winders P, Sgro M, Feldman W, Macarthur C. Antibiotics for the Treatment of Aspiration Pneumonia—Reply. Arch Pediatr Adolesc Med. 1998;152(2):208. doi: