Retropharyngeal Abscess in a Penicillin-Allergic Patient When IV Antibiotic Therapy Has Not Achieved Clinical Improvement
This protocol applies to patients with retropharyngeal abscess who have a previous anaphylactic reaction to penicillin and who have not responded adequately to initial intravenous antibiotic management. The combination of severe penicillin allergy and antibiotic treatment failure defines a specific escalation pathway.
A previous anaphylactic reaction to penicillin precludes the use of penicillin and related beta-lactam agents. Patients in this group require an adapted management approach throughout their care.
Initial management in this penicillin-allergic patient included airway management, hydration, analgesia, and intravenous clindamycin in place of the standard penicillin/beta-lactam regimen. Clinical improvement was not achieved within 48 hours of initiating intravenous antibiotic therapy — the threshold that triggers escalation to this protocol.
References
- Patients with previous anaphylactic reactions to penicillin may be treated with clindamycin.
- For PPA and RPA, an oral approach is suggested when possible.
- However, PPAs (that are only partially seen in the pharynx) and complicated RPAs must be treated by an external cervical approach as the intraoral approach can be dangerous or would allow full drainage.
- However, surgery should be preceded by a careful evaluation of the patency of the airways.
- An emergency tracheotomy can be required, and this explains why some experts suggest that this must be anticipated in all cases of severe DNI.