Aspiration pneumonia is an important and frequent complication following aspiration of infectious material from the oropharynx or stomach. Therefore the microbiological flora generally comprises a mixed spectrum of microbes including aerobic, microaerobic and anaerobic mircoorganisms. There are a number of risk factors for aspiration such as compromised consciousness or esophageal diseases. Aspiration pneumonia presents as a subacute or chronic disease. An endoscopic inspection of the bronchial system and a bacteriological evaluation should be performed in all patients. The principal therapeutic strategy for aspiration pneumonia is an antibiotic therapy. In uncomplicated cases a treatment for 7-10 days should be sufficient, but in case of complications like necrotizing pneumonia or lung abscess a prolonged administration (14-21 days, up to weeks or months) will be necessary. Recommended antibiotic regimens include clindamycin +/- cephalosporin, ampicillin/sulbactam and moxifloxacin.