Retropharyngeal Abscess Medication

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Intravenous broad-spectrum antibiotic coverage is indicated in the treatment of retropharyngeal abscess.

 

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Antibiotics

Class Summary

 

Gram-positive organisms (including beta-lactamase – producing microbes), gram-negative organisms, and anaerobes must be covered. The Sanford Guide to Antimicrobial Therapy recommends adding empiric vancomycin to the regimen if the patient is in a high-risk group. [11]

In a review of retropharyngeal infections in children, Wald recommended adding vancomycin or linezolid to the regimen in patients who do not respond to clindamycin and in those who present with severe disease, in order to cover MRSA. [4]

 

Empiric Therapy (does not address possible infection with S aureus or P aeruginosa) [11] :

Ceftriaxone + metronidazole

Levofloxacin + clindamycin

Ampicillin-sulbactam

 

Directed/Specific Therapy [11] :

     Positive culture or high risk for S aureus:

            add vancomycin

     Positive culture of high risk for P aeruginosa:

            Piperacillin-tazobactam

            Cefepime + metronidazole

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Cephalosporins, 3rd Generation

Ceftriaxone (Rocephin)

Third-generation cephalosporin with broad-spectrum gram-negative activity; has lower efficacy against gram-positive organisms but higher efficacy against resistant organisms; highly stable in presence of beta-lactamases (penicillinase and cephalosporinase) of gram-negative and gram-positive bacteria; bactericidal activity results from inhibiting cell-wall synthesis by binding to 1 or more penicillin-binding proteins; exerts antimicrobial effect by interfering with synthesis of peptidoglycan (major structural component of bacterial cell wall); bacteria eventually lyse because activity of cell-wall autolytic enzymes continues while cell-wall assembly is arrested.

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Nitroimidazoles

Metronidazole (Flagyl, Flagyl ER, Flagyl IV RTU)

Inhibits nucleic acid synthesis by disrupting DNA and causing strand breakage; amebicidal, bactericidal, trichomonacidal

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Fluoroquinolones

Levofloxacin (Levaquin, Levofloxacin Systemic)

L-stereoisomer of parent compound ofloxacin; D-isomer form is inactive

Inhibits DNA gyrase activity, which in turn promotes breakage of DNA strands

Good monotherapy with extended coverage against Pseudomonas spp, as well as excellent activity against pneumococcus

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Antibiotics, Lincosamide

Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)

Suppresses protein synthesis by binding to 50S ribosomal subunits; bacteriostatic or bactericidal depending on drug concentration, organism and infection site

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Penicillins, Amino

Ampicillin/sulbactam (Unasyn)

Drug combination of beta-lactamase inhibitor with ampicillin; interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms; alternative to amoxicillin when unable to take medication orally; covers skin, enteric flora, and anaerobes; not ideal for nosocomial pathogens.

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Glycopeptides

Vancomycin (Firvanq, Vancocin)

Inhibits cell-wall biosynthesis; blocks glycopeptide polymerization by binding tightly to D-alanyl-D-alanine portion of cell wall precursor

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Penicillins, Extended-Spectrum

Piperacillin/tazobactam (Zosyn)

Antipseudomonal penicillin plus beta-lactamase inhibitor; inhibits biosynthesis of cell wall mucopeptide synthesis by binding to 1 or more of the penicillin-binding proteins and is effective during active-multiplication stage

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Cephalosporins, Other

Cefepime (Maxipime)

Fourth-generation cephalosporin; has gram-negative coverage comparable to ceftazidime but better gram-positive coverage (comparable to ceftriaxone); is zwitterion and rapidly penetrates gram-negative cells; is best beta-lactam for IM administration; has poor capacity to cross blood-brain barrier and thus is not used for treatment of meningitis

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