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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
Insights
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.
Objective:
To determine the effectiveness of using intravenous antibiotics alone to treat clinically stable children with clearly defined deep neck abscesses diagnosed by contrast-enhanced computed tomography (CT).
Design:
Retrospective chart and CT scan review.
Setting:
Tertiary care children's hospital.
Patients:
The study comprised clinically stable pediatric patients who presented with signs and symptoms of a deep neck infection and who had CT scans demonstrating an abscess in the parapharyngeal space, retropharyngeal space, or both that included (1) a well-formed ring enhancement around a nonenhancing density consistent with fluid and (2) a size greater than 1 cm in every dimension.
Main Outcome Measures:
Clinical resolution of the signs and symptoms of the deep neck abscess after treatment with intravenous antibiotics.
Results:
Over a 22-month period (May 1999 to March 2001), 11 children ranging in age from 4 months to 16(1/2) years who had contrast-enhanced CT evidence of deep neck abscess and no clinical evidence of severe symptoms or significant airway compromise were initially treated with intravenous antibiotics. Ten (91%) of the 11 children responded to intravenous antibiotic therapy as their only treatment. All 10 responders began to improve clinically by 48 hours. The symptoms resolved in 5 children by treatment day 3. Five to 8 days of treatment were required to completely resolve the symptoms in the other 5 patients. The 1 child who did not respond to intravenous antibiotic therapy underwent surgical drainage of her deep neck abscess within 12 hours of admission, with purulence discovered at the time of surgery.
Conclusion:
In a select number of clinically stable children, deep neck abscesses diagnosed on contrast-enhanced CT scans using strict radiographic criteria can be effectively treated with intravenous antibiotics alone.
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