This protocol addresses children older than 12 months and younger than 7 years presenting with retropharyngeal, parapharyngeal, or pharyngeal abscess who are ill-appearing, have unstable vital signs, and raise concern for airway compromise — without penicillin allergy, immunocompromise, prior neck or airway surgery, septic shock, active airway compromise, or head/neck trauma.
When inpatient PICU-level care — including IV antibiotic therapy with Ampicillin/Sulbactam plus Vancomycin, supportive management, and planned step-down to oral antibiotics — does not achieve the expected goals within 24–48 hours (patient not yet well-appearing, vital signs not yet stable, fever curve and labs not improving, not tolerating oral intake), the clinical situation calls for the next defined step outlined in this protocol.
At this stage, the approach centres on keeping the patient NPO and obtaining CT imaging after discussion with ENT. The complete structured regimen — including the full decision pathway — is in the protocol.
DOI: 10.3390/children9050618