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 common 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, 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
- Third generation cephalosporin, e.g.
Ceftriaxone, IV, 80 mg/kg/dose once daily.
PLUS
- Metronidazole, IV, 7.5 mg/kg/dose 8 hourly.
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanic acid, oral, 30 mg/kg/dose of the amoxicillin component 8 hourly.
Note: S. aureus and M. tuberculosis are also etiological agents. Adjust antibiotics once culture and sensitivity results are available.
Penicillin allergy
See Chapter 24: Drug Allergies, Allergies to penicillins .
For pain and fever:
- Paracetamol, oral, 15 mg/kg/dose 6 hourly as required.
REFERRAL
- All children.