Adequate antibiotics with surgical source control in case of loculated collections are essential for successful management of these infections.
Patients with risk factors for MRSA infection should be treated empirically with linezolid (600 mg orally or IV every 12 hours) or vancomycin (15 to 20 mg/kg IV every 12 hours). Risk factors for MRSA include a history of healthcare exposure, indwelling lines/ devices, intravenous drug use, co-morbid disease (e.g., diabetes mellitus, CKD on dialysis), prior history of MRSA infection and residing in a community or hospital where there is a substantial incidence of MRSA.
Antibiotics guidelines for deep neck space infections
| Site of infection | Organisms | Immunocompetent | Immunosuppressed |
|---|---|---|---|
| Peri-tonsillar abscess (Quinsy) | S.pyogenes, Oral anaerobes |
Clindamycin OR Ampicillin-sulbactum ORAmoxicillin-clavulanate |
Piperacillin-tazobactam |
| Suppurative parotitis | Streptococci, oral anaerobes | Clindamycin OR Ampicillin-sulbactumOR Amoxicillin-clavulanate |
Piperacillin-tazobactam plusClindamycin |
| Note:Urgent ENT reference in case of obstructed salivary duct | |||
| Ludwig’s angina | Streptococci, oral anaerobes | Clindamycin OR Ampicillin-sulbactum OR Amoxicillin-clavulanate |
Piperacillin-tazobactam Plus Clindamycin |
| Odontogenic | Viridians and other streptococci, Peptostreptococcus and other oral anaerobes | Clindamycin OR Ampicillin-sulbactum OR Amoxicillin-clavulanate |
Piperacillin-tazobactam Plus Clindamycin |
| Rhinogenic | S.pneumoniae, H.influenzae, streptococci, anaerobes | Ceftriaxone + linezolid | Piperacillin-tazobactam + Clindamycin |
| Otologic | S.pneumoniae, H.influenzae, streptococci, anaerobes | Ceftriaxone Plus Metronidazole |
Piperacillin-tazobactam + Clindamycin |
| Prevertebral abscess | S.aureus, facultative gram negative anaerobes |
Linezolid ORVancomycin PLUS Ciprofloxacin |
Piperacillin-tazobactam + Clindamycin |
| Lemierre syndrome (Septic jugular thrombophlebitis) | Fusobacterium necrophorum, Streptococcus, anaerobes | Piperacillin-tazobactam Plus Clindamycin |
Piperacillin-tazobactam Plus Clindamycin |
#Enterobacteriaceae must be considered as potential pathogens in immunosuppressed hosts (neutropenics, diabetics, critically ill, postoperative infections & trauma)
**Drainage of abscess/ collection where possible should be carried out