20 - Retropharyngeal Abscess

Abstract

The patient suffering from retropharyngeal abscess initially presents with sore throat, neck pain, and painful and difficult swallowing. This pain becomes more intense and localized as the abscess increases in size and compresses adjacent structures. Low-grade fever and vague constitutional symptoms, including malaise and anorexia, progress to frank sepsis with high-grade fever, rigors, and chills. At this point, the mortality rate associated with retropharyngeal abscess rises dramatically, despite treatment with appropriate antibiotics and surgical drainage of the abscess. Because many retropharyngeal abscesses are caused by Staphylococcus aureus, the initial antibiotic regimen should include vancomycin to treat staphylococcal infection. Gram-negative and anaerobic antibiotic coverage should also be started empirically immediately after blood and urine culture samples are taken. Antibiotic therapy can be tailored to the culture and sensitivity reports as they become available.