7.6 Head and neck abscesses (peritonsillar / parapharyngeal and retropharyngeal abscess)

Type of Infection	First Line (with Dosage and Duration)	Alternative First Line (with dosage and Duration)	Comments
Patient- hemodynamically stable and immunocompetent	Amoxicillin-clavulanate 1.2g IV TDS for 7 days	Inj Ceftriaxone 2g IV OD + Inj Metronidazole 500mg IV TDS for 7 days	Consider surgical drainage with general measures like pain control and radiologic evaluation and airway management. Work up for tuberculosis as per indication. Treatment for 2-3 weeks depending on source control and patient’s clinical response.
Patient hemodynamically unstable or presence of immunocompromising condition	Inj Piperacillin-tazobactam 4.5g IV q6h + Inj Clindamycin 600mg IV TDS for 7 days	Inj Meropenem 1g IV TDS + Inj Vancomycin 1g q12h/ Inj Teicoplanin 400mg IV BD for 3 doses and then 400mg OD for 7 days	Work up for tuberculosis as per indication. Treatment for 2-3 weeks depending on source control and patient's clinical response.

Type of Infection

First Line
(with Dosage and Duration)

Alternative First Line
(with dosage and Duration)

Comments

Patient- hemodynamically stable and immunocompetent

Amoxicillin-clavulanate 1.2g IV TDS for 7 days

Inj Ceftriaxone 2g IV OD + Inj Metronidazole 500mg IV TDS for 7 days

Consider surgical drainage with general measures like pain control and radiologic evaluation and airway management. Work up for tuberculosis as per indication. Treatment for 2-3 weeks depending on source control and patient’s clinical response.

Patient hemodynamically unstable or presence of immunocompromising condition

Inj Piperacillin-tazobactam 4.5g IV q6h

Inj Clindamycin 600mg IV TDS for 7 days

Inj Meropenem 1g IV TDS

Inj Vancomycin 1g q12h/ Inj

Teicoplanin 400mg IV BD for 3 doses and then 400mg OD for 7 days

Work up for tuberculosis as per indication.

Treatment for 2-3 weeks depending on source control and patient's clinical response.

For common etiological agents of Head and neck abscesses (peritonsillar / parapharyngeal and retropharyngeal abscess), see Annexure B.7.6

Additional Information

A pure submental abscess like presentation should be evaluated for Ludwig's angina.