This protocol applies to children older than 12 months and under 7 years — particularly those under 2 years of age or with a history of MRSA — presenting with retropharyngeal, parapharyngeal, or pharyngeal abscess. The child is hemodynamically stable, non-toxic in appearance, and handling secretions, with no airway compromise, no penicillin allergy, no immunocompromise, no prior neck or airway surgery, no sepsis or shock, and no head, neck, or airway trauma.
The preceding step was inpatient admission with IV antibiotic therapy using Ampicillin/Sulbactam plus Clindamycin, with a planned transition to oral antibiotics (Amoxicillin/Clavulanate) once clinical improvement was evident. The expected milestones — well-appearing with stable vital signs, an improving fever curve and laboratory values, and tolerance of oral intake within 24–48 hours — were not achieved. This protocol defines the clinical path taken when that threshold is not met.
When the expected clinical milestones are not reached, management advances to a specialist-coordinated evaluation pathway, including keeping the patient NPO. The complete protocol specifies the full decision sequence and next actions.
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. NPO. CT order after discussion with ENT.
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