Management of retropharyngeal abscess in children

OR: operating room; CT: computed tomography; IV: intravenous.
* The differential diagnosis of retropharyngeal infection includes other conditions that cause upper airway obstruction, sore throat, and/or neck stiffness. The diagnosis of retropharyngeal cellulitis or abscess is made by a combination of physical findings and confirmatory imaging. For further discussion, refer to UpToDate topics on retropharyngeal infections in children.
¶ CT of the neck with intravenous contrast is the best tool to identify abscesses in the retropharyngeal area. Anesthesiology and otolaryngology should be consulted and present for CT if significant airway compromise is anticipated from positioning or sedation during the procedure.
Δ For specific antibiotic recommendations, refer to UpToDate topics on retropharyngeal infections. Empiric therapy should include coverage for Group A Streptococcus, Staphylococcus aureus, and respiratory anaerobes. The choice of initial antibiotics should take into account the severity of disease and the local prevalence of methicillin-resistant S. aureus. Empiric therapy can be amended as necessary based upon culture results if drainage is performed or clinical response to treatment. When tailoring therapy based upon culture results, it is important to bear in mind that retropharyngeal infections are frequently polymicrobial and not all microbes are consistently cultured.