This protocol addresses the escalation step for children older than 12 months and younger than 7 years admitted with retropharyngeal, parapharyngeal, or pharyngeal abscess and a documented penicillin allergy who have not improved as expected on their initial inpatient antibiotic course.
The child is non-toxic in appearance, hemodynamically stable, and handling secretions. A penicillin allergy is present. The child is not immunocompromised, has no prior neck or airway surgery, no signs of sepsis or shock, no airway compromise, and no head, neck, or airway trauma.
The prior inpatient step for this penicillin-allergic child was initiated with Clindamycin IV, with a planned step-down to oral Clindamycin on improvement. The expected goals — a well-appearing child with stable vital signs, an improving fever trend and laboratory values, and tolerance of oral medication and diet by 24–48 hours — were not achieved. This protocol is the structured next step taken after that failure to improve.
DOI: 10.3390/children9050618