Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess: a prospective observational study

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  • Tejs Ehlers Klug
  • Camilla Andersen
  • Pernille Hahn, Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Lillebaelt, Vejle
  • ,
  • Christian Sander Danstrup, Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg
  • ,
  • Niels Krintel Petersen, Department of Otorhinolaryngology - Head and Neck Surgery,Aarhus Universitetshospital,Denmark.
  • ,
  • Sophie Mikkelsen, Department of Otorhinolaryngology, Head and Neck Surgery, Aalborg University Hospital, Aalborg
  • ,
  • Helle Døssing, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense
  • ,
  • Anne-Louise Christensen, Department of Otorhinolaryngology, Head and Neck Surgery, Regional Hospital Holstebro
  • ,
  • Maria Rusan
  • Anette Kjeldsen, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Odense University Hospital, Odense
  • ,
  • Thomas Greve

PURPOSE: We aimed to evaluate the effectiveness of different antibiotic regimens for the treatment of parapharyngeal abscess (PPA) and characterize patients, who suffered potentially preventable complications (defined as death, abscess recurrence, spread of infection, or altered antibiotic treatment because of insufficient progress).

METHODS: Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments.

RESULTS: Surgical treatment included internal incision (100%), external incision (13%), and tonsillectomy (88%). Patients were treated with penicillin G ± metronidazole (n = 39), cefuroxime ± metronidazole (n = 16), or other antibiotics (n = 5). Compared to penicillin-treated patients, cefuroxime-treated patients were hospitalized for longer (4.5 vs 3.0 days, p = 0.007), were more frequently admitted to intensive care (56 vs 15%, p = 0.006), underwent external incision more frequently (31 vs 5%, p = 0.018), and suffered more complications (50 vs 18%, p = 0.022), including re-operation because of abscess recurrence (44 vs 3%, p < 0.001). Nine patients suffered potentially preventable complications. These patients displayed significantly higher C-reactive protein levels, received antibiotics prior to admission more frequently, underwent external incision more commonly, and were admitted to intensive care more frequently compared to other patients.

CONCLUSION: The majority of patients with PPA were effectively managed by abscess incision, tonsillectomy, and penicillin G ± metronidazole. Cefuroxime-treated patients were more severely ill at time of admission and had worse outcome compared to penicillin-treated patients. We recommend penicillin G + metronidazole as standard treatment for patients with PPA, but in cases with more risk factors for potentially preventable complications, we recommend aggressive surgical and broadened antibiotic therapy, e.g. piperacillin-tazobactam.

Original languageEnglish
JournalEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN0937-4477
DOIs
Publication statusE-pub ahead of print - 1 Jul 2021

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