Parapharyngeal Abscess Without Penicillin Anaphylaxis: What to Do When Initial Antibiotic Therapy Has Not Produced Clinical Improvement Within 48 Hours
This protocol addresses patients with parapharyngeal abscess who have no history of anaphylactic reaction to penicillin and who have not shown clinical improvement within 48 hours of starting intravenous antibiotic treatment.
No previous anaphylactic reaction to penicillin. This is clinically significant: the treatment options appropriate for this population differ from those indicated when penicillin anaphylaxis is present.
Initial management included airway evaluation and high-dose parenteral broad-spectrum antibiotic therapy (with or without an anti-anaerobic agent), as indicated for this population. The criterion for escalating to this protocol is failure to achieve clinical improvement within 48 hours of initiating intravenous antibiotic therapy.
When intravenous antibiotics have not achieved the expected response within 48 hours, the approach shifts to surgical drainage of the abscess. The technique and access route are determined by careful pre-operative assessment — not all cases are managed the same way.
References
DOI: 10.3390/children9050618
Patients with previous anaphylactic reactions to penicillin may be treated with clindamycin.
However, surgery should be preceded by a careful evaluation of the patency of the airways.
For PPA and RPA, an oral approach is suggested when possible.
However, PPAs (that are only partially seen in the pharynx) and complicated RPAs must be treated by an external cervical approach as the intraoral approach can be dangerous or would allow full drainage.
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