Treatment of Retropharyngeal Abscess with Penicillin Allergy in Children (Age 1–7 Years)

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 concern for airway compromise, and have unstable vital signs — with a known history of penicillin allergy.

Clinical Scenario

The patient is ill-appearing with concern for airway compromise and unstable vital signs. A history of penicillin allergy is documented. This protocol applies when the patient is not immunocompromised, not septic or in shock, has no prior neck or airway surgery, and has no head, neck, or airway trauma.

Management Approach (Partial)

PICU-level admission is indicated. Management includes IV antibiotic therapy selected with penicillin allergy in mind, coordination with ENT, and supportive care measures. The full antibiotic regimen and step-down approach are detailed in the complete protocol…

Treatment Goals

Well-appearing with stable vital signs, improving fever curve and labs, and tolerating oral medication and diet within 24–48 hours of antibiotic treatment.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.3390/children9050618

Patient >12 months and <7 years old. Retropharyngeal; parapharyngeal; pharyngeal abscess. Ill-appearing. Concern for airway compromise. Unstable vital signs. PICU with penicillin allergy. Immunocompromised. Prior neck or airway surgery. Patient appears septic/in shock. Compromised airway. Head/neck/airway trauma.

Start PICU IV Antibiotics. Continue PICU IV Antibiotics. NPO. IVF maintenance. Pain control. Coordinate care with ENT. Avoid Ketorolac.

Well-appearing, vital signs stable. Labs/fever curve improving. Tolerating PO medication and diet.

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