What is the role of antibiotics in the treatment of deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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  • Choose parenteral antibiotics to cover the most likely organisms.

  • Initiate empiric regimens before culture results are obtained based on the local resistance patterns and most common etiologies.

  • Cover gram-positive and gram-negative organisms and aerobic and anaerobic bacteria, including beta-lactamase–producing organisms. [3]

  • Modify antibiotics according to culture and sensitivity results.

  • A review of deep neck infections by Broughton indicated that 50% of deep neck infections can be managed nonsurgically in patients with small fluid collections and no respiratory compromise. Other studies by Plaza and McClay support the option of primary nonsurgical management for selected deep neck space abscesses, reserving surgical drainage for patients who do not improve within 48 hours of initiation of broad-spectrum intravenous antibiotics. [23, 24] Most of these studies focus on retropharyngeal and parapharyngeal space abscesses.

  • A review of current practices by Lalakea and Messner indicated that 60% of pediatric otolaryngologists recommend a trial of IV antibiotics before incision and drainage in selected pediatric patients with retropharyngeal abscesses. [25] According to this review, clindamycin, ampicillin/sulbactam, and cefuroxime are currently the most commonly used antibiotics.

  • IV antibiotics are administered until the patient is clinically improving and has been afebrile for at least 48 hours. After completion of an IV course of antibiotics, oral antibiotics are given.

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