Pediatric Guidelines: Head and Neck Infections - Lymphadenitis

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 faciliate 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

Staphylococcus aureus

Group A streptococcus

Occasional anaerobes

Clindamycin 10mg/kg/dose PO/IV q8h (max 600mg/dose PO, 900mg/dose IV)   If lack of response to empiric therapy, consider need for drainage, or alternative etiology besides typical bacteria - consider ID consult

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. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).