This protocol addresses the child aged over 12 months and under 7 years who presents with a retropharyngeal, parapharyngeal, or pharyngeal abscess, appears ill, has a documented penicillin allergy, and has unstable vital signs — and who has not achieved the expected milestones after the initial PICU-based treatment course.
The patient is a young child (age >12 months, <7 years) with a deep neck space abscess (retropharyngeal, parapharyngeal, or pharyngeal). Concern for airway compromise and unstable vital signs are present. The patient is ill-appearing. A penicillin allergy is documented. The patient is not immunocompromised, has no prior neck or airway surgery, is not septic or in shock, has no compromised airway, and has no head, neck, or airway trauma.
The previous step was admission to the PICU with IV antibiotic therapy and supportive care (in the context of penicillin allergy). The goals of that line — becoming well-appearing with stable vital signs, showing an improving fever curve and improving laboratory values, and tolerating oral medication and diet within 24–48 hours of antibiotic treatment — were not achieved. This protocol is the structured next step when that threshold is not met.