Treatment of aspiration or tracheostomy-associated pneumonia in neurologically impaired children: effect of antimicrobials effective against anaerobic bacteria

The purpose of the present study was to retrospectively review the antibiotic therapy of aspiration or tracheostomy-associated pneumonia in 57 neurologically impaired children (NIC). The antimicrobials used were either ticarcillin-clavulanate or clindamycin, which are effective against penicillin-resistant anaerobic bacteria, or ceftriaxone, which is less effective against these organisms. In those with aspiration pneumonia, a satisfactory clinical and microbiological response was observed in 8/9 (89%) patients who received ticarcillin-clavulanate, and 10/11 (91%) who received clindamycin with or without ceftazidime, as compared to 7/14 (50%) who received ceftriaxone (P < 0.05). For those who experienced tracheostomy-associated pneumonia, a positive response to therapy was observed in 5/6 (83%) who received ticarcillin-clavulanate, and 7/7 (100%) who received clindamycin with or without ceftazidime, as opposed to 4/10 (40%) who were treated with ceftriaxone (P < 0.05). The duration of fever was longer in both cases for those who received ceftriaxone. To summarize, this study illustrates the superiority of antimicrobials effective against penicillin-resistant anaerobic bacteria, as compared to an antibiotic without such coverage, in the therapy of aspiration or tracheostomy-associated pneumonia in NIC.