Microbiology and antibiotic treatment of head and neck abscesses in children

Abstract

The clinical data, microbiological results and antibiotic treatment of 65 children who have required incision and drainage of suppurative head and neck abscesses was retrospectively investigated with the aim of developing a more effective clinical protocol of treatment, improving speed of resolution and rationalizing the need for surgical intervention. A positive culture grew in 78% of children and of these 45% were Staphylococcus aureus, 9% Streptococcus pyogenes, and 8% atypical mycobacteria. Only 3% of the samples grew anaerobes. All isolates of S. aureus were sensitive to Flucloxacillin and all isolates of S. pyogenes were sensitive to penicillin. All anaerobes were Metronidazole sensitive. In 40% of the children there were no localizing symptoms which could guide the treatment, therefore we recommend Flucloxacillin and Metronidazole as the antibiotic regimen of choice in acute suppurative lymphadenitis. The increasing incidence of atypical mycobacterial lymphadenitis is noteworthy.

Analysis of Life-Threatening Complications of Deep Neck Abscess and the Impact of Empiric Antibiotics

“…and Peptostreptococcus sp. When nature barriers are broken, these bacteria could cause severe deep neck Sakaguchi et al [3] penicillin derivative and clindamycin A (91) Japan Parhiscar et al [13] penicillin G with oxacillin or nafcillin P and A (210) USA Gates [5] penicillin, ␤-lactamase-resistant drug such as clindamycin, chloramphenicol or gentamicin NA USA Chen et al [6] penicillin G, gentamicin and clindamycin A (214) Taiwan Chen et al [7] penicillin G, gentamicin and clindamycin A (105) Taiwan Plaza et al [8] cefotaxime and metronidazole A (31) Spain Simo et al [12] flucloxacillin and metronidazole P (65) UK Nagy et al [9] ceftriaxone and clindamycin NA USA McClay et al [10] cefuroxime and clindamycin P (11) USA Sichel et al [20] amoxicillin-clavulanic acid P (6), A (1) Israel Brondbo et al [21] penicillin G, metronidazole A (1) Canada…”

“…Surgical drainage is of utmost importance in the treatment of deep neck abscess. Antimicrobial therapy effective against the aerobic and anaerobic bacteria is also essential in reaching complete resolution of the abscess [11,12] .…”

Suppurative lymphadenitis

“…Furthermore, prior empiric antibiotic therapy may confound culture results. In a retrospective review of 65 children undergoing incision and drainage of superfi cial head and neck abscesses (presumed to have arisen from suppurating lymph nodes) in the United Kingdom (1991)(1992)(1993)(1994)(1995)(1996), bacterial cultures were positive in 78% of children, with the most common organisms being S. aureus and S. pyogenes (57% and 12% of positive cultures, respectively) [9]. In a similar analysis involving 62 children in Philadelphia, PA (2000PA ( -2006, bacterial cultures were positive in 79% of children, with the most common organisms again being S. aureus and S. pyogenes (63% and 22% of positive cultures, respectively) [10].…”

Surgical treatment for chronic cervical lymphadenitis in children. Experience from a tertiary care paediatric centre on non-tuberculous mycobacterial infections

“…They are usually located in the anterior submandibular triangle, and in the high cervical neck including jugodigastric levels, posterior triangle lymph nodes, or preauricular/parotid area. Their clinical course could vary from spontaneous cure to progression and spontaneous fistulisation; the latter situation is usually due to the liquefying process of the affected lymph node, which turns into a fluctuant lesion with necrosis in the granulomatous centre and with a characteristic changing in its overlying skin to a purple colour [18,19]. 80% of the patients presenting to a head and neck surgeon are at this stage [20,21].…”