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.