Pediatric Retropharyngeal Abscess Medication

Updated: Feb 14, 2023
  • Author: Vijay A Patel, MD; Chief Editor: Ravindhra G Elluru, MD, PhD  more...
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Medication Summary

Initiate empiric parenteral antibiotic therapy early in patients with concern for RPA. Provide broad-spectrum coverage for gram-positive, gram-negative aerobes, and anaerobes.

Although penicillin G and metronidazole were once considered the mainstays of therapy, the increasing presence of beta-lactamase–producing bacteria forced practice away from this combination. Treatment may be initiated with a beta-lactamase–resistant combination penicillin (eg, ticarcillin-clavulanate, piperacillin-tazobactam, or ampicillin-sulbactam). In some cases, when concern for MRSA is present, treatment would likely be managed with clindamycin or vancomycin.


Penicillins, Amino

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 contains 2 g ampicillin and 1 g sulbactam.

Amoxicillin/clavulanate (Augmentin, Augmentin ES-600, Augmentin XR)

Amoxicillin binds to penicillin-binding proteins, thus inhibiting final transpeptidation step of peptidoglycan synthesis in bacterial cell walls; addition of clavulanate inhibits beta-lactamase-producing bacteria, allowing amoxicillin extended spectrum of action.



Vancomycin (Vancocin, Firvanq)

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



Clindamycin (Cleocin, Cleocin Pediatric, ClindaMax Vaginal)

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


Cephalosporins, 2nd Generation

Cefuroxime (Ceftin, Zinacef)

Second generation cephalosporin which binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase.

Cefoxitin (Mefoxin)

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


Penicillins, Extended-Spectrum

Piperacillin/tazobactam (Zosyn)

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

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.