Antibiotic therapy for pediatric deep neck abscesses: A systematic review

ObjectiveTo evaluate the current evidence regarding the safety and efficacy of medical management for deep neck abscesses in children.Data sourcesPubmed and Embase databases accessed 3/27/2012.Review methodsAn a priori protocol defining inclusion and exclusion criteria was developed to identify all articles addressing medical therapy of pediatric deep neck abscesses where details regarding diagnostic criteria, specifics of medical therapy and definitions of failure were presented. The search included electronic databases to identify candidate articles as well as a manual crosscheck of references. The level of evidence was assessed and data extracted by three authors independently. Data were pooled using a random effects model due to significant study heterogeneity.ResultsEight articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I2 = 98.8%; p < .001). However, each article uniformly presented cases suggesting that medical therapy may be a viable alternative to surgical drainage in some patients. The pooled success rate of medical therapy in avoiding surgical drainage in children with deep neck infections was 0.517 (95%CI: 0.335, 0.700). When patients taken immediately to surgery were excluded and patients were placed on author defined medical protocols, the success rate increased to 0.951 (95%CI: 0.851, 1.051). Subgroup analysis by duration of intravenous antibiotic trial greater than 48 h demonstrated a pooled success rate of 0.740 (95%CI: 0.527, 0.953).ConclusionThe current literature suggests medical management may be a safe alternative to surgical drainage of deep neck abscesses in children. However, the level of evidence lacks strength and further investigation is warranted.