Treatment of Retropharyngeal Abscess in Children Aged 12 Months to Under 7 Years (Including History of MRSA)

This protocol applies to paediatric patients over 12 months and under 7 years old — in particular those under 2 years of age or with a history of MRSA — presenting with retropharyngeal, parapharyngeal, or pharyngeal abscess who are non-toxic in appearance and haemodynamically stable.

Clinical Scenario

Age >12 months and <7 years; inpatient pathway applies if under 2 years old and/or history of MRSA
Retropharyngeal, parapharyngeal, or pharyngeal abscess
Non-toxic appearance; handling secretions; haemodynamically stable
No penicillin allergy; not immunocompromised; no prior neck or airway surgery
No compromised airway, no sepsis or shock, no head/neck/airway trauma

Treatment Approach

Management involves admission to General Pediatrics with inpatient IV antibiotic therapy, supportive care, and a structured step-down to oral antibiotics once clinical improvement is established.

The complete drug selection, dosing, step-down criteria, and full algorithm are available in the structured protocol below.

Clinical Goals

Well-appearing child with stable vital signs
Improving fever curve and laboratory values
Tolerating oral medication and diet within 24–48 hours of treatment

Instant Access to Structured Evidence-Based Regimens

REFERENCES

DOI: 10.3390/children9050618

Patient >12 months and <7 years old
Retropharyngeal; parapharyngeal; pharyngeal abscess
Inpatient if <2 years old and/or history of MRSA
Non-toxic · Handling secretions · Hemodynamically stable
Start Inpatient IV Antibiotics · Continue Inpatient IV Antibiotics
Pain control · IVF maintenance · Diet as tolerated · Avoid Ketorolac
Well-appearing, vital signs stable · Labs/fever curve improving · Tolerating PO medication and diet

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