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 |
|---|---|---|---|---|
| Peritonsillar/ retropharyngeal abscess |
Group A streptococcus Staphylococcus aureus Oral anaerobes |
Inpatient: Ampicillin-sulbactam (Unasyn) If patient has airway compromise, extensive abscess that will be drained, or history of documented MRSA infection or carriage within the last 6 months: ADD Vancomycin (follow link for dosing & monitoring) -------------------------- Outpatient/step down therapy: Amoxicillin-clavulanate (Augmentin) |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Clindamycin OR Clindamycin |
Urgent OHNS consult recommended to evaluate need for source control Consider ID consult (see details above) Duration: 10-14 days based on severity and response to treatment If Vancomycin was started and MRSA not recovered from drained abscess, discontinue Vancomycin *See guidance on Amoxicillin-Clavulanate maximum dosing and formulations |
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.