Deep neck space infection

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Case Definition:

Retropharyngeal abscesses develop after an upper respiratory infection that causes lymphadenitis in the retropharyngeal space, these abscesses are rare and usually occur in children. They can be associated with tuberculosis of the cervical spine. Parapharyngeal abscesses occur in the potential space lateral to the pharynx and can arise following tonsillitis or an infected lower third molar. Abscess cavities can track inferiorly to affect the mediastinum.

 

Diagnostic criteria:

Presentation is with a sore throat, pyrexia and trismus. The posterior pharyngeal wall may be swollen (retropharyngeal) or the tonsil may be pushed medially with an associated neck swelling (parapharyngeal). Infection caused by Fusobacterium necrophorum  can cause thrombosis of the jugular vein and multiple pulmonary abscesses (Lemierre's syndrome).

 

Specimens to be collected:

Pus can be obtained if the abscess requires surgical drainage.

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)
A

Minor to moderate infection

Review doses in renal impairment

CO-AMOXICLAV 625mg po tds

If current/previous MRSA positive:

Add

DOXYCYCLINE 200mg po od

Typical total duration: 14 days

CLINDAMYCIN 450mg po qds

If current/previous MRSA positive:

Add

DOXYCYCLINE 200mg po od

Typical total duration: 14 days

B/C

Moderate to severe life threatening infection 

Review doses in renal impairment

BENZYLPENICILLIN 2.4g iv qds
Plus
GENTAMICIN iv (as per local protocol) 
Plus
METRONIDAZOLE 400mg po tds

If current/previous MRSA positive:

Add

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

Typical total duration: 14 days

 

CLINDAMYCIN 1.2g iv qds
Plus
GENTAMICIN iv (as per local protocol)

If current/previous MRSA positive:

Add

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose

<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
 

Maintain treatment pending pre-dose (trough) level on Day 5. Target level 15-60mg/L.

 

 

Typical total duration: 14 days

 

IV to Oral Switch (explanatory notes See category A

See category A

Last reviewed: 23/04/14

For guidance on the administration of intravenous antibiotics
click here (GHNHSFT intranet only)