Obstruction should be intubated and transferred to a pediatric

ICU.

2. Hydration. Should be provided by IV fluids in patients unable to take oral fluids and in those who present with dehydration.

3. Pain relief. Pain should be treated with analgesics, such as acetaminophen and ibuprofen. If pain is severe, consider use of codeine or parenteral analgesics.

4. Antibiotic therapy. Used to treat cervical adenitis, retropha-ryngeal cellulitis and abscess, and peritonsillar abscess. Antibiotic selection should be based on the causative agents and generally includes use of one or more of the following: nafcillin, ampicillin, ampicillin-sulbactam, clindamycin, cefurox-ime, and ceftriaxone. Improvement should be seen within 48 hours.

5. Needle aspiration. May be helpful in the treatment of fluctuant lesions, but avoid if mycobacterial infection is suspected. Needle aspiration may also be used in cat-scratch disease if lesions are particularly painful.

6. Incision and drainage of cervical and retropharyngeal abscesses. Generally performed by a trained pediatric otolaryngologist. Need for surgical drainage should be determined by the degree of respiratory compromise, patient's response to antibiotic therapy, and reaccumulation of fluid following needle aspiration (eg, with cervical abscesses). Gauze packing typically is used to allow for healing by secondary intention.

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