- Oropharyngeal flora (Streptococcus species · oral anaerobes · Enterobacteriaceae · Haemophilus influenzae)
- Risk context (Neurologic impairment · GERD · swallowing dysfunction · recent aspiration event)
First-line therapy
Ampicillin/sulbactam • i.v. • 50–50 mg/kg/dose • 4×/day
Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Duration: 5 days · Extend to 7 days if slow response; ampicillin component dosing
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Amoxicillin/clavulanate • p.o. • 45–45 mg/kg/dose • 2×/day
Dose is calculated using the amoxicillin component.
Max 875 mg/dose (amoxicillin) · Duration: 5 days · Extend to 7 days if slow response; amoxicillin component dosing
- • Step-down oral therapy when clinically stable — review IV antibiotics by 48 h (UCSF, NICE).
- • Community-onset aspiration pneumonia with symptoms >48 h after aspiration event.
- • Not indicated for aspiration pneumonitis (chemical injury improving within 24–48 h).
Enter weight on Kids to calculate doses
Clinical notes
- • Aspiration pneumonitis (chemical injury) usually improves within 24–48 h — antibiotics are not indicated.
- • Antibiotics do not prevent pneumonia after an isolated aspiration event.
- • Routine separate anaerobic coverage beyond ampicillin/sulbactam or amoxicillin/clavulanate is not recommended (NICE 2025).
- • Review IV therapy by 48 h; step down to oral when stable. If no signs of infection at 72 h, consider stopping.
- • Obtain cultures before antibiotics if feasible; reassess and de-escalate based on response.
- • AAP Red Book — Pneumonia and Aspiration (2024)
- • PIDS/IDSA Clinical Practice Guideline — Pediatric CAP (principles applicable) (2011)
- • ESPID Guideline (2024)
+ 2 more
- • NICE / NHS Scotland — Pediatric Aspiration Pneumonia (2025)
- • WHO Pocket Book of Hospital Care for Children (2022)
