Pediatric Retropharyngeal Abscess Medication

  • Author: Jason L Acevedo, MD; Chief Editor: Glenn C Isaacson, MD, FACS, FAAP   more...
 
Updated: Jul 22, 2011
 

Medication Summary

Initiate empiric parenteral antibiotic therapy early in patients with a retropharyngeal abscess. Provide broad-spectrum coverage for gram-positive and gram-negative aerobes and anaerobes. Although penicillin G and metronidazole once were considered the mainstays of therapy, the increasing presence of beta-lactamase–producing bacteria has forced current practice away from this combination. Now clindamycin is considered first-line treatment. Treatment may be initiated alone or in combination with cefoxitin or a beta-lactamase–resistant combination penicillin (eg, ticarcillin/clavulanate, piperacillin/tazobactam, ampicillin/sulbactam).

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

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Clindamycin (Cleocin)

 

Lincosamide that inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Cefoxitin (Mefoxin)

 

Second-generation cephalosporin indicated for gram-positive cocci and gram-negative rod infections. Bactericidal and inhibits cell wall synthesis.

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Ticarcillin and clavulanate potassium (Timentin)

 

Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth. Antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive and gram-negative organisms and most anaerobes. Timentin 3.1 g contains 3 g of ticarcillin and 0.1 g of clavulanate.

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Piperacillin and tazobactam sodium (Zosyn)

 

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication. Zosyn 3.375 contains 3 g of piperacillin and 0.375 g of tazobactam.

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Ampicillin and sulbactam (Unasyn)

 

Ampicillin is a semisynthetic penicillin and is bactericidal, inhibiting cell wall synthesis. Sulbactam is a beta-lactamase inhibitor. 3 g Unasyn contain 2 g ampicillin and 1 g sulbactam.

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Contributor Information and Disclosures
Author

Jason L Acevedo, MD  Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Department of Otolaryngology, Fort Sill, Oklahoma

Jason L Acevedo, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery and American College of Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Rahul K Shah, MD, FACS, FAAP  Assistant Professor of Otolaryngology and Pediatrics, George Washington University School of Medicine and Health Sciences; Attending Physician, Department of Otolaryngology, Children's National Medical Center

Rahul K Shah, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Medical Quality, American College of Physician Executives, American College of Surgeons, Massachusetts Medical Society, Phi Beta Kappa, and Triological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Orval Brown, MD  Director of Otolaryngology Clinic, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center at Dallas

Orval Brown, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, American Society of Pediatric Otolaryngology, Society for Ear, Nose and Throat Advances in Children, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John E McClay, MD  Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School

John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Glenn C Isaacson, MD, FACS, FAAP  Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Temple University School of Medicine

Glenn C Isaacson, MD, FACS, FAAP is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society of Pediatric Otolaryngology, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Covidien Honoraria Consulting

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Todd J Berger, MD, and Hosseinali Shahidi, MD, MPH, to the original development and writing of this article.

References

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A schematic of the anatomy of the deep spaces of the neck, as illustrated in lateral and cross-sectional views. The fascial planes, defined by the color key, surround the potential spaces. The retropharyngeal space is bounded anteriorly by the buccal pharyngeal fascia, which invests the pharynx, trachea, esophagus, and thyroid. The retropharyngeal space is bounded posteriorly by the alar fascia and laterally by the carotid sheaths and parapharyngeal spaces. It extends from the base of the skull to the mediastinum at the level of the tracheal bifurcation. Note the danger space located between the alar fascia and the prevertebral fascia.
Plain film soft tissue views of the lateral neck. The top radiograph reveals a widening of the soft tissues, with anterior displacement of the airway. Careful examination of the top film reveals gas in the soft tissue. The bottom radiograph is much more subtle. The soft tissue is widened at the level of C2.
A contrast axial contrast CT scan demonstrates a left sided retropharyngeal abscess.
 
 
 
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