Intravenous Antibiotics Sufficient Therapy for Many Deep Neck Abscesses

Abstract

Otolaryngology| March 01 2004 Intravenous Antibiotics Sufficient Therapy for Many Deep Neck Abscesses AAP Grand Rounds (2004) 11 (3): 29–30. https://doi.org/10.1542/gr.11-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Intravenous Antibiotics Sufficient Therapy for Many Deep Neck Abscesses. AAP Grand Rounds March 2004; 11 (3): 29–30. https://doi.org/10.1542/gr.11-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: abscess, antibiotic therapy, intravenous, neck Source: McClay JE, Murray AD, Booth T. Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography. Arch Otolaryngol Head Neck Surg. 2003;129:1207–1212. In this report, the authors from the University of Texas at Southwestern Medical School and Children’s Hospital of Dallas sought to determine the effectiveness of using intravenous (IV) antibiotics alone to treat children with clinically stable deep neck abscesses diagnosed by contrast-enhanced computed tomography (CT). Using a retrospective chart review and CT-scan review, the authors identified 11 clinically stable patients with contrast-enhanced CT evidence of retropharyngeal, lateral pharyngeal, or combined space abscesses (defined as a well-formed ring enhancement surrounding a non-enhancing density and a size greater than 1 cm in all dimensions) who were initially treated with IV antibiotics without surgical drainage. Patients with severe symptoms, airway compromise, or those who underwent immediate surgical drainage were excluded. Ten (91%) of 11 children, ranging in age from 4 months to 8.7 years, responded to IV antibiotic therapy. All 10 responders began to improve within 48 hours. Five patients were complete responders within 3 days. However, the other 5 patients required 5 to 8 days of IV antibiotics for complete resolution of symptoms. The only teenager in the group (age 16 years) was a non-responder and required surgery. The authors conclude that a trial of IV antibiotics could be considered before immediate surgical drainage is performed in children with deep neck abscess who are clinically stable. In the pre-CT era, the diagnosis of a retropharyngeal or lateral pharyngeal abscess was based on the constellation of clinical symptoms, physical signs, and sub-optimal imaging studies. Since the advent of CT with contrast, the finding of a ring-enhancing hypodense area clinches the diagnosis of deep neck abscess.1 Or does it? The authors of the report summarized above define a ring-enhanced hypolucency greater than 1 cm in all dimensions as an abscess. However, does that necessarily mean that the patient requires surgery to eradicate the infection, or might IV antibiotic therapy be sufficient treatment? In the preantibiotic era, all patients suspected of having a deep neck abscess underwent surgery for drainage. In the antibiotic era and before CT scanning, many patients with only cellulitis or suppurative lymphadenitis were probably overtreated with surgery and antibiotic therapy. However, without an imaging modality that could confirm the presence or absence of an abscess, a conservative approach made sense. Surgical drainage of an abscess arrested the spread of infection through the fascial planes into the mediastinum and prevented further localized swelling and the respiratory compromise that could follow. Contrast CT-scanning provides a means of visualizing the infectious process, but the question of when surgical intervention is necessary remains. At what size does a radiographic abscess require surgical drainage rather than empiric IV therapy alone? This study sheds some light on that question. As a retrospective review with relatively few patients, there may be an inherent bias in the study’s findings. However, 4 of the 10 patients treated successfully with... You do not currently have access to this content.