Retropharyngeal Abscess Treatment in Children with Penicillin Allergy (Ages 1–7)

This protocol addresses children older than 12 months and younger than 7 years presenting with a retropharyngeal, parapharyngeal, or pharyngeal abscess who have a documented penicillin allergy.

The child is non-toxic in appearance, hemodynamically stable, and handling secretions. There is no compromised airway, no sepsis or shock, no immunocompromised state, and no prior neck or airway surgery.

Management involves inpatient admission to General Pediatrics with IV antibiotic therapy. Because penicillin cannot be used, the regimen is adjusted — Clindamycin is the antibiotic at the centre of this approach.

Supportive care, including pain control and IV fluid maintenance, is provided alongside antibiotics. On clinical improvement, the plan transitions to the next phase of treatment.

Dosing, sequencing, step-down criteria, and the complete regimen are in the full protocol below.

The child should appear well with stable vital signs, an improving fever curve and laboratory findings, and the ability to tolerate oral medication and diet within 24–48 hours of starting antibiotic treatment.