Neck Infection — Antibiotic Recommendations — Clinical Pathway: Emergency

Deep Neck Space Infection Clinical Pathway — Emergency Department

Antibiotic Recommendations

Indications First-Line Therapy Allergy to First-Line β-lactam
Assess Need for Alternative
  • Deep neck space infection including:
    • Retropharyngeal abscess (RPA)
    • Lateral pharyngeal abscess (LPA)
    • Parapharyngeal abscess (PPA)

Non-severe Disease

  • No MRSA risk factors:
    • Ampicillin/sulbactam, IV
      • 50 mg/kg/dose of ampicillin component every 6 hours;
        Maximum 2,000 mg of ampicillin component/dose
  • If MRSA risk factor(s) present:
    • Clindamycin, IV
      • 14 mg/kg/dose every 8 hours
        Maximum 900 mg/dose
  • If prior history of clindamycin-resistant MRSA, therapy guided by prior isolate’s susceptibility
  • MRSA risk factors include:
    • History of prior MRSA infection or carriage
    • Known close/household contact with MRSA
    • Use of IV drugs

Non-severe Disease

  • No MRSA risk factors:
    • Clindamycin, IV
      • 14 mg/kg/dose every 8 hours
        Maximum 900 mg/dose

Severe Disease
(E.g., ICU admission, concern for airway compromise; patients with sepsis should be treated per Sepsis, ED, Inpatient, PICU)

  • Ampicillin/sulbactam, IV
    • 50 mg/kg/dose of ampicillin component every 6 hours;
      Maximum 2,000 mg of ampicillin component/dose
  • And
  • Vancomycin, IV
    • < 50 kg
      • 15 mg/kg/dose every 6 hours
        Maximum 750 mg/dose
    • ≥ 50 kg and/or > 18 yrs
      • 15 mg/kg/dose every 8 hours
        Maximum 1,000 mg/dose

Severe Disease

  • Ceftriaxone, IV
    • 100 mg/kg/dose IV every 24 hours
      Maximum 2,000 mg/dose
  • And
  • Vancomycin, IV
    • < 50 kg
      • 15 mg/kg/dose every 6 hours
        Maximum 750 mg/dose
    • ≥ 50 kg and/or > 18 yrs
      • 15 mg/kg/dose every 8 hours
        Maximum 1,000 mg/dose
  • And
  • Metronidazole, IV
    • Infants PMA ≥ 44 wks, children, adolescents, and adults
      • 7.5 mg/kg/dose every 6 hours
        Maximum 500 mg/dose

CHOP Formulary for complete drug information.