Need for drainage/source control of head and neck infections should be evaluated carefully in consultation with Pediatric Otolaryngology, Head and Neck Surgery. If initial non-operative management is chosen, a narrow spectrum regimen (i.e. without vancomycin) is encouraged to facilitate transition to oral therapy.
ID consultation is recommended for head and neck infections occurring in immunocompromised patients, and for those with atypical features, chronic course, or lack of response to first line therapy.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Lymphadenitis - acute, suppurative bacterial, usually unilateral Usual presentation, without suspected dental source (e.g. periodontal disease, poor dental hygiene) |
Staphylococcus aureus Group A streptococcus
|
Cephalexin 25 mg/kg/dose (max 500 mg/dose) enterally tid OR Cefazolin 25 mg/kg/dose (max 1000 mg/dose) IV q8h Choice of IV vs. enteral depending on illness severity; switch to enteral route upon clinical improvement |
Penicillin or cephalosporin allergy with higher risk for allergic reaction OR history of documented MRSA infection or carriage within the last 6 months Please confirm clindamycin susceptibility if prior cultures are available, tailor antibiotics to past susceptibility: Clindamycin OR Clindamycin |
Consider OHNS consult to evaluate need for source control If lack of response to empiric therapy, consider need for drainage, or alternative etiology besides typical bacteria - consider ID consult (also see details above) Duration: 10 days (or 5-7 days after abscess drainage if applicable) |
|
Lymphadenitis - acute, suppurative bacterial, usually unilateral With suspected dental source (e.g. concurrent periodontal disease) |
Oral streptococci and anaerobes |
Amoxicillin-clavulanate (Augmentin) 22.5 mg amoxicillin/kg/ dose (max 875 mg amoxicillin/dose) enterally bid OR Ampicillin-sulbactam (Unasyn) 50 mg ampicillin/kg/dose (max 2000 mg ampicillin/dose) IV q6h Choice of IV vs. enteral depending on illness severity, switch to enteral route upon clinical improvement |
Penicillin or cephalosporin allergy with higher risk for allergic reaction OR history of documented MRSA infection or carriage within the last 6 months Please confirm clindamycin susceptibility if prior cultures are available, tailor antibiotics to past susceptibility: Clindamycin OR Clindamycin |
Consider OHNS consult to evaluate need for source control If lack of response to empiric therapy, consider need for drainage, or alternative etiology besides typical bacteria - consider ID consult (also see details above) Duration: 10 days (or 5-7 days after abscess drainage if applicable) |
Reference:
American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.