Aspiration Pneumonia

Similar to pathogens in community-acquired pneumonia and hospital-acquired pneumonia, depending on setting 

Anaerobic organisms may be involved though usually the oral anaerobic flora are frequently susceptible to usual therapy for pneumonia (e.g. ampicillin)  

If symptoms resolve within 24-48 hours of  initial aspiration event: 

This presentation is consistent with aspiration pneumonitis. Antibiotic therapy is not recommended. Antibiotic therapy is also not recommended at this time based on an aspiration event alone (i.e. for prevention of pneumonia).  

For symptoms consistent with aspiration pneumonia developing or lasting >48 hours after initial aspiration event, with community onset (not hospital): 

Ampicillin-sulbactam (Unasyn)
50 mg ampicillin/kg/dose IV q6h (max 2000 mg ampicillin/dose) 

Enteral/transition therapy: 
Amoxicillin-clavulanate (Augmentin)
45 mg amoxicillin/kg/ dose enterally bid (max 1000 mg amoxicillin/dose) 

Penicillin or cephalosporin allergy with higher risk for allergic reaction: 

Clindamycin
10 mg/kg/dose (max 900mg/dose) IV q8h

OR

Clindamycin 10mg/kg/dose (max 600 mg/dose) enterally tid  

Oral hygeine and regular dentistry care are important to reduce risk for aspiration pneumonia in neurologically impaired patients

Follow guidelines for Healthcare-acquired Pneumonia if infection developed in the hospital

Review intravenous antibiotics by 48 hours and consider switching to enteral route if possible