This protocol addresses the child older than 12 months and under 7 years — specifically 2 years of age or older — presenting with a retropharyngeal, parapharyngeal, or pharyngeal abscess who is non-toxic in appearance, hemodynamically stable, handling secretions, and has no penicillin allergy, no history of MRSA, no immunocompromise, no prior neck or airway surgery, no compromised airway, no head or neck trauma, and is not septic or in shock.
Key qualifying features for this scenario:
Previous treatment did not achieve its goals. The patient was admitted to General Pediatrics and started on inpatient IV antibiotic therapy with Ampicillin/Sulbactam, with a planned step-down to oral Amoxicillin/Clavulanate upon clinical improvement. The expected milestones — well-appearing with stable vital signs, an improving fever curve and labs, and tolerating oral medication and diet by 24–48 hours of antibiotic treatment — were not met. This protocol defines the next management step after that failure.
Patient >12 months and <7 years old
Retropharyngeal; parapharyngeal; pharyngeal abscess
Non-toxic
Handling secretions
Hemodynamically stable
Immunocompromised
Prior neck or airway surgery
Patient appears septic/in shock
Compromised airway
Head/neck/airway trauma
Inpatient if <2 years old and/or history of MRSA
NPO
CT order after discussion with ENT
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