Retropharyngeal Abscess

1. Treatment consists of antibiotic coverage against the most common pathogens and, usually, surgical drainage. Most abscesses are polymicrobial and contain a combination of GABHS, anaerobic bacteria, and S aureus. Less common pathogens include Hib, Klebsiella pneumoniae, and Streptococcus pneumoniae.

2. Combination therapy with clindamycin and a third-generation cephalosporin or single therapy using ampicillin-sulbactam is an excellent choice for initial coverage. Further therapy should be guided by sensitivities of organism(s) obtained on culture.

C. Lateral Neck or Pharyngeal Abscess. Treatment consists of antibiotic coverage against the most common pathogens (see preceding discussion). Surgical therapy is dictated by size of the abscess and space involved.

D. Peritonsillar Abscess. Almost always caused by GABHS or oral anaerobes, or both. Penicillin is the drug of choice; clindamycin is an alternative. Surgical intervention with needle aspiration, incision, and drainage, or tonsillectomy may be necessary.

E. Epiglottitis. Endotracheal intubation is frequently necessary, and IV antibiotic therapy should target Hib. Use third-generation cephalosporin or ampicillin-sulbactam because of increasing ampicillin resistance of H influenzae. S aureus, S pneumoniae, and GABHS are occasionally isolated.

F. Bacterial Tracheitis. Endotracheal intubation is frequently necessary, and antibiotic therapy should target S aureus, GABHS, Moraxella catarrhalis, and S pneumoniae.

VI. Problem Case Diagnosis. On physical examination, the 8-year-old boy had asymmetric peritonsillar tissue with displacement of the uvula to the right. CT exam confirmed the diagnosis of peritonsillar abscess.

VII. Teaching Pearl: Question. What are three nonsuppurative complications of GABHS pharyngitis?

VIII. Teaching Pearl: Answer. Acute rheumatic fever, poststreptococcal glomerulonephritis, and toxin-mediated disease (GABHS toxic shock syndrome).

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