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 |