Retropharyngeal Abscess
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This emergency condition refers to collection of pus in the retropharyngeal space. Early diagnosis and treatment will prevent mortality.
Cause
- Group A -haemolytic Streptococcus
- Staphylococcus aureus
- Osteomyelitis of cervical vertebrae from tuberculosis
Symptoms
- Fever
- Sore throat
- Difficulty in swallowing
- Hyperextension of neck
- Laboured and noisy breathing
Signs
- Fever
- Reddened throat, large and inflammed tonsils
- Laboured respiration with intercostal retractions
- Stridor
- Bulge in the posterior pharyngeal wall
Investigations
- FBC
- Throat swab for culture and sentivity testing
- Ziehl-Neelsen stain to exclude tuberculosis
- Lateral soft tissue X-ray of neck
- Chest X-ray to exclude tuberculosis
TreatmentTreatment Objectives
- To treat infection
- To relieve the obstruction by draining the abscess
- To relieve pain
Non-pharmacological treatment
- Incision and drainage of pus under general anaesthesia
Pharmacological treatment
For pain relief
1st Line Treatment
Evidence Rating: [B]
- Paracetamol, oral,
Adults
500 mg-1 g 4-6 hourly
Children
6-12 years; 250-500 mg 4-6 hourly
1-5 years; 120-250 mg 4-6 hourly
3 months-1 year; 60-120 mg 4-6 hourly
For treatment of infection
1st Line Treatment
Evidence Rating: [B]
- Cefuroxime, IV,
Adults
750 mg-1.5 g 8 hourly for 72 hours
Children
25 mg/kg 8 hourly for 72 hours
And
- Metronidazole, IV,
Adults
500 mg 8 hourly for 72 hours
Children
7.5 mg/kg 8 hourly for 72 hours
Then
- Cefuroxime, oral,
Adults
500 mg 12 hourly for 7 days
Children
12-18 years; 250 mg 12 hourly for 7 days
2-12 years; 15 mg/kg (max. 250mg) 12 hourly for 7 days
3 months-2 years; 10mg/kg (max. 125mg) 12 hourly for 7 days
And
- Metronidazole, oral,
Adults
400 mg 8 hourly for 7 days
Children
7.5 mg/kg 8 hourly for 7 days
2nd Line Treatment
Evidence Rating: [B]
- Flucloxacillin, IV,
Adults
500 mg 6 hourly for 72 hours
Children
50-100 mg/kg 6 hourly for 72 hours
And
- Metronidazole, IV,
Adults
500 mg 8 hourly for 72 hours
Children
7.5 mg/kg 8 hourly for 72 hours
Then
- Metronidazole, oral,
Adults
400 mg 8 hourly for 7 days
Children
7.5 mg/kg 8 hourly for 7 days
And
- Flucloxacillin, oral,
Adults
500 mg 6 hourly for 7 days if patient is able to swallow
Children
50 mg/kg 6 hourly for 7 days if patient is able to swallow
Referral CriteriaRefer all cases to the ENT specialist.