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Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography
John E McClay1, Alan D Murray, Tim Booth
1Department of Otolaryngology-Head and Neck Surgery, University of Texas at Southwestern Medical School and Children's Hospital of Dallas, 73235, USA. john.mcclay@utsouthwestern.edu
Archives of Otolaryngology--Head & Neck Surgery
|November 19, 2003
Summary
Intravenous antibiotics alone effectively treated deep neck abscesses in most clinically stable children. This approach, confirmed by contrast-enhanced computed tomography (CT), showed a 91% success rate, avoiding surgery for most pediatric patients.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Radiology
Background:
- Deep neck abscesses in children often require surgical intervention.
- Accurate diagnosis using advanced imaging like contrast-enhanced computed tomography (CT) is crucial.
- Identifying criteria for non-surgical management can improve patient outcomes and reduce healthcare costs.
Purpose of the Study:
- To evaluate the efficacy of intravenous antibiotics as monotherapy for deep neck abscesses in select pediatric patients.
- To determine if contrast-enhanced CT findings can predict successful non-surgical treatment.
- To establish criteria for selecting children with deep neck abscesses suitable for antibiotic-only management.
Main Methods:
- Retrospective review of pediatric patient charts and CT scans.
- Inclusion criteria focused on clinically stable children with deep neck abscesses (parapharyngeal or retropharyngeal) meeting specific CT criteria (ring enhancement, size >1 cm).
- Intravenous antibiotics were the primary treatment; clinical resolution was the main outcome measure.
Main Results:
- Eleven children with deep neck abscesses diagnosed by contrast-enhanced CT were treated with intravenous antibiotics.
- Ten out of eleven (91%) children responded successfully to antibiotic therapy alone.
- Clinical improvement was observed within 48 hours for responders, with complete symptom resolution in 5-8 days. One child required surgery.
Conclusions:
- Intravenous antibiotics alone can be an effective treatment for carefully selected, clinically stable children with deep neck abscesses.
- Strict adherence to radiographic criteria on contrast-enhanced CT aids in identifying suitable candidates for non-surgical management.
- This approach offers a viable alternative to surgery in a significant proportion of pediatric deep neck infections.