Aspiration Pneumonia

Patient Population: Pediatric
Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments
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

10 mg/kg/dose (max 900mg/dose) IV q8h


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


Metlay JP, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, Volume 200, Issue 7, 1 October 2019, Pages e45-e67.

Thomson J, Hall M, Ambroggio L, Berry JG, Stone B, Srivastava R, Shah SS. Antibiotics for Aspiration Pneumonia in Neurologically Impaired Children. J Hosp Med. 2020 Jul 1;15(7):395-402.

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.