Abscess, Retropharyngeal
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J39.0 DESCRIPTION An infective process of the retropharyngeal space either due to: abscess formation in a retropharyngeal lymph node (lymphadenitis), rarely, extension of infection from surrounding tissues, or rarely, local injury. Always consider cold abscess of TB as a possible cause.
General and supportive measures
ICD-10 code: J39.0
DESCRIPTION
An infective process of the retropharyngeal space either due to:
- abscess formation in a retropharyngeal lymph node (lymphadenitis),
- rarely, extension of infection from surrounding tissues, or
- rarely, local injury.
Always consider cold abscess of TB as a possible cause.
DIAGNOSTIC CRITERIA
Clinical
- In severe cases, stridor and difficulty in breathing,
- More commonly, fever with dysphagia and drooling,
- May have extension of the neck, or torticollis and,
- Swelling, usually in the midline of posterior pharyngeal wall.
Investigations
- Lateral X-ray of the neck may show the retropharyngeal space to be more than one-half of the width of the adjacent vertebral bodies when the neck is extended; air may be seen in the retropharynx and there is loss of the cervical lordosis.
- Blood cultures.
GENERAL AND SUPPORTIVE MEASURES
- Referral to ENT for surgical drainage of abscesses.
- Protect the airway.
- Ensure adequate hydration, either IV fluids or by NGT.
MEDICINE TREATMENT
Empirical antibiotic therapy
- Initiate antibiotic treatment immediately even if transfer of the patient is anticipated.
- Adjust antibiotic therapy based on culture results, if available.
- Early cases may be treated with antibiotic therapy alone.
- Amoxicillin/clavulanic acid, IV, 25 mg/kg/dose of the amoxicillin component 8 hourly (do not exceed 10 mg/kg/day of the clavulanic acid component).
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly for 14 days (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly.
Note: S. aureus and M. tuberculosis are also etiological possible agents. Adjust antibiotics once culture and sensitivity results are available.
Penicillin allergy:
See: Drug Allergies, Allergies to penicillin.
For pain and fever:
Paracetamol, oral, 15 mg/kg/dose 6 hourly as required.
REFERRAL
- All children.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.1 Abscess, Retropharyngeal