Treatment

Patients with a confirmed diagnosis of retropharyngeal abscess should be admitted to the hospital and receive IV antibiotics, along with consultation from otolaryngology. (1)

Antibiotic therapy should target upper respiratory organisms, including anaerobic organisms. Those presenting with airway compromise require immediate surgical incision and drainage to alleviate the obstruction.,

Management of the condition typically initiates with a 24- to 48-hour trial of IV antibiotic therapy in patients who do not present with severe respiratory distress or airway compromise. Following 24 to 48 hours of antibiotic therapy, an otolaryngologist should reassess the need for surgical incision and drainage.

Initial antibiotic therapy should include either ampicillin-sulbactam (50 mg/kg every 6 hours) or clindamycin (15 mg/kg every 8 hours). In cases where patients exhibit signs of sepsis or are unresponsive to initial antibiotic therapy, vancomycin or linezolid may also be administered.

Parenteral antibiotics should be continued until patients show clinical improvement and remain afebrile for at least 24 hours. After patients demonstrate improvement and remain afebrile, they may be transitioned to oral antibiotics.

Amoxicillin-clavulanate (45 mg/kg every 12 hours) or clindamycin (13 mg/kg every 8 hours) are suitable oral regimens. Oral antibiotics should be prescribed for 14 days, and the patient may be discharged home with strict return precautions.

Surgical intervention should be strongly considered if symptoms fail to improve after 24 to 48 hours of antibiotic therapy or if the abscess exceeds 2 to 2.5 cm. (2)

Reference

1. Lorrot M et al. Antibiotherapy of severe ENT infections in children: peripharyngeal abscesses. Arch Pediatr. 2013 Nov;20 Suppl 3:e1-4
2. Kosko J, Casey J. Retropharyngeal and parapharyngeal abscesses: Factors in medical management failure. Ear Nose Throat J. 2017 Jan;96(1):E12-E