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* Deep neck infection | * Deep neck infection | ||
:* Empiric antimicrobial therapy | :* Empiric antimicrobial therapy<ref>{{cite book | last = Flint | first = Paul | title = Cummings otolaryngology head & neck surgery | publisher = Mosby/Elsevier | location = Philadelphia, PA | year = 2010 | isbn = 978-0323052832 }}</ref><ref>{{Cite journal| doi = 10.1016/j.otc.2008.01.002| issn = 0030-6665| volume = 41| issue = 3| pages = 459–483, vii| last1 = Vieira| first1 = Francisco| last2 = Allen| first2 = Shawn M.| last3 = Stocks| first3 = Rose Mary S.| last4 = Thompson| first4 = Jerome W.| title = Deep neck infection| journal = Otolaryngologic Clinics of North America| date = 2008-06| pmid = 18435993}}</ref> | ||
::* Community-acquired deep neck infection | ::* Community-acquired deep neck infection | ||
:::* Preferred regimen: [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg daily (if ''[[Eikenella]]'' is suspected) | :::* Preferred regimen: [[Ampicillin-Sulbactam]] 1.5–3.0 g IV q6h {{or}} [[Clindamycin]] 600–900 mg IV q8h {{or}} [[Moxifloxacin]] 400 mg daily (if ''[[Eikenella]]'' is suspected) | ||
| Line 13: | Line 12: | ||
::* Necrotizing fasciitis | ::* Necrotizing fasciitis | ||
:::* Preferred regimen: [[Ceftriaxone]] 2.0 g IV q8h {{and}} [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Metronidazole]] 500 mg IV q6h | :::* Preferred regimen: [[Ceftriaxone]] 2.0 g IV q8h {{and}} [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Metronidazole]] 500 mg IV q6h | ||
:* Specific anatomic considerations<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref> | |||
::* '''Submandibular space infections including Ludwig angina''' | |||
:::* Causative pathogens | |||
::::* Viridans and other streptococci | |||
::::* Peptostreptococcus | |||
::::* Bacteroides | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Tobramycin]] 2 mg/kg IV q8h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h {{or}} [[Doxycycline]] 200 mg IV q12h {{or}} [[Cefoxitin]] 2 g IV q6h {{or}} [[Cefotetan]] 2 g IV q12h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} Imipenem 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Gatifloxacin]] 200 mg IV q24h | |||
::* '''Lateral pharyngeal or retropharyngeal space infections (odontogenic)''' | |||
:::* Causative pathogens | |||
::::* Viridans and other streptococci | |||
::::* Staphylococcus | |||
::::* Peptostreptococcus | |||
::::* Bacteroides | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} Imipenem 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h | |||
::* '''Lateral pharyngeal or retropharyngeal space infections (rhinogenic)''' | |||
:::* Causative pathogens | |||
::::* Streptococcus pyogenes | |||
::::* Fusobacterium | |||
::::* Peptostreptococcus | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} Imipenem 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h | |||
::* '''Lateral pharyngeal or retropharyngeal space infections (otogenic)''' | |||
:::* Causative pathogens | |||
::::* Streptococcus pneumoniae | |||
::::* Haemophilus influenzae | |||
::::* Viridans and other streptococci | |||
::::* Peptostreptococcus | |||
::::* Bacteroides | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} Imipenem 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h | |||
::* '''Peritonsillar abscess (quinsy)''' | |||
:::* Causative pathogens | |||
::::* Viridans and other streptococci | |||
::::* Peptostreptococcus | |||
::::* Bacteroides | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h {{or}} [[Cefoxitin]] 2 g IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | |||
::* '''Suppurative parotitis''' | |||
:::* Causative pathogens | |||
::::* Staphylococcus | |||
::::* Viridans and other streptococci | |||
::::* Bacteroides | |||
::::* Peptostreptococcus | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): ([[Nafcillin]] 1.5 g IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h | |||
::* '''Extension of osteomyelitis from prevertebral space infection''' | |||
:::* Causative pathogens | |||
::::* Staphylococcus | |||
::::* Facultative gram-negative bacilli | |||
:::* Preferred regimen (immunocompetent host): ([[Nafcillin]] 1.5 g IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ciprofloxacin]] 200 mg q12h | |||
:::* Preferred regimen (immunocomppromised host): ([[Vancomycin]] 0.5 g IV q6h {{and}} [[Cefotaxime]] 2 g IV q6h) {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h | |||
::* '''Pott's puffy tumor (frontal osteitis)''' | |||
:::* Causative pathogens | |||
::::* Streptococcus pyogenes | |||
::::* Fusobacterium | |||
::::* Peptostreptococcus | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): [[Penicillin G]] 2–4 MU IV q4–6h {{or}} ([[Ciprofloxacin]] 200 mg q12h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Gatifloxacin]] 400 mg IV q24h {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h | |||
::* '''Malignant otitis media''' | |||
:::* Causative pathogens | |||
::::* Pseudomonas aeruginosa | |||
:::* Preferred regimen (immunocompetent host): [[Ciprofloxacin]] 200 mg q12h {{or}} ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | |||
::* '''Petrous osteitis''' | |||
:::* Causative pathogens | |||
::::* Pseudomonas aeruginosa | |||
:::* Preferred regimen (immunocompetent host): [[Ciprofloxacin]] 200 mg q12h {{or}} ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): ([[Tobramycin]] 2 mg/kg IV q8h {{and}} [[Ceftazidime]] 2 g IV q6h) {{or}} [[Piperacillin]] 3 g IV q4h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h | |||
::* '''Septic jugular thrombophlebitis (Lemierre syndrome)''' | |||
:::* Causative pathogens | |||
::::* Fusobacterium | |||
::::* Viridans and other streptococci | |||
::::* Staphylococcus | |||
::::* Peptostreptococcus | |||
::::* Bacteroides | |||
::::* Other oral anaerobes | |||
:::* Preferred regimen (immunocompetent host): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h) {{or}} [[Ampicillin-Sulbactam]] 2 g IV q4h {{or}} [[Clindamycin]] 600 mg IV q6h | |||
:::* Preferred regimen (immunocomppromised host): [[Cefotaxime]] 2 g IV q6h {{or}} [[Ceftizoxime]] 4 g IV q8h {{or}} [[Piperacillin]] 3 g IV q4h {{or}} Imipenem 500 mg IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Gatifloxacin]] 400 mg IV q24h | |||
Latest revision as of 07:02, 11 June 2015
- Deep neck infection
-
- Community-acquired deep neck infection
- Preferred regimen: Ampicillin-Sulbactam 1.5–3.0 g IV q6h OR Clindamycin 600–900 mg IV q8h OR Moxifloxacin 400 mg daily (if Eikenella is suspected)
- Nosocomial deep neck infection or immunocompromised host
- Preferred regimen: Ticarcillin-Clavulanate 3.0 g IV q6h OR Piperacillin-Tazobactam 3.0 g IV q6h OR Imipenem-Cilastatin 500 mg IV q6h OR Ciprofloxacin 400 mg IV q12h OR Levofloxacin 750 mg IV q24h
- Deep neck infection with high-risk of MRSA
- Preferred regimen: (Clindamycin 600–900 mg IV q8h OR Trimethoprim-Sulfamethoxazole 10 mg/kg/day IV q8h) AND Vancomycin 1.0 g IV q12h
- Necrotizing fasciitis
- Preferred regimen: Ceftriaxone 2.0 g IV q8h AND Clindamycin 600–900 mg IV q8h AND Metronidazole 500 mg IV q6h
- Specific anatomic considerations[3]
- Submandibular space infections including Ludwig angina
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h OR Doxycycline 200 mg IV q12h OR Cefoxitin 2 g IV q6h OR Cefotetan 2 g IV q12h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Gatifloxacin 200 mg IV q24h
- Lateral pharyngeal or retropharyngeal space infections (odontogenic)
- Causative pathogens
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
- Lateral pharyngeal or retropharyngeal space infections (rhinogenic)
- Causative pathogens
- Streptococcus pyogenes
- Fusobacterium
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
- Lateral pharyngeal or retropharyngeal space infections (otogenic)
- Causative pathogens
- Streptococcus pneumoniae
- Haemophilus influenzae
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
- Peritonsillar abscess (quinsy)
- Causative pathogens
- Viridans and other streptococci
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h OR Cefoxitin 2 g IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h
- Suppurative parotitis
- Causative pathogens
- Staphylococcus
- Viridans and other streptococci
- Bacteroides
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Nafcillin 1.5 g IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): (Vancomycin 0.5 g IV q6h AND Cefotaxime 2 g IV q6h) OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h
- Extension of osteomyelitis from prevertebral space infection
- Causative pathogens
- Staphylococcus
- Facultative gram-negative bacilli
- Preferred regimen (immunocompetent host): (Nafcillin 1.5 g IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ciprofloxacin 200 mg q12h
- Preferred regimen (immunocomppromised host): (Vancomycin 0.5 g IV q6h AND Cefotaxime 2 g IV q6h) OR Ceftizoxime 4 g IV q8h OR Imipenem 500 mg IV q6h
- Pott's puffy tumor (frontal osteitis)
- Causative pathogens
- Streptococcus pyogenes
- Fusobacterium
- Peptostreptococcus
- Other oral anaerobes
- Preferred regimen (immunocompetent host): Penicillin G 2–4 MU IV q4–6h OR (Ciprofloxacin 200 mg q12h AND Metronidazole 0.5 g IV q6h) OR Gatifloxacin 400 mg IV q24h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
- Malignant otitis media
- Causative pathogens
- Pseudomonas aeruginosa
- Preferred regimen (immunocompetent host): Ciprofloxacin 200 mg q12h OR (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host): (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h
- Petrous osteitis
- Causative pathogens
- Pseudomonas aeruginosa
- Preferred regimen (immunocompetent host): Ciprofloxacin 200 mg q12h OR (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h
- Preferred regimen (immunocomppromised host): (Tobramycin 2 mg/kg IV q8h AND Ceftazidime 2 g IV q6h) OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h
- Septic jugular thrombophlebitis (Lemierre syndrome)
- Causative pathogens
- Fusobacterium
- Viridans and other streptococci
- Staphylococcus
- Peptostreptococcus
- Bacteroides
- Other oral anaerobes
- Preferred regimen (immunocompetent host): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h) OR Ampicillin-Sulbactam 2 g IV q4h OR Clindamycin 600 mg IV q6h
- Preferred regimen (immunocomppromised host): Cefotaxime 2 g IV q6h OR Ceftizoxime 4 g IV q8h OR Piperacillin 3 g IV q4h OR Imipenem 500 mg IV q6h OR Imipenem 500 mg IV q6h OR Gatifloxacin 400 mg IV q24h
- ↑ Flint, Paul (2010). Cummings otolaryngology head & neck surgery. Philadelphia, PA: Mosby/Elsevier. ISBN 978-0323052832.
- ↑ Vieira, Francisco; Allen, Shawn M.; Stocks, Rose Mary S.; Thompson, Jerome W. (2008-06). "Deep neck infection". Otolaryngologic Clinics of North America. 41 (3): 459–483, vii. doi:10.1016/j.otc.2008.01.002. ISSN 0030-6665. PMID 18435993. Check date values in:
|date=(help) - ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.