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.