When might a child's pus collection in the throat be treated with antibiotics without surgery?

Details

The study aimed to describe clinical presentations, bacteriological results, and treatment management in children with acute pharyngeal suppuration—pus collections in the throat. It also sought clinical, bacteriological, and radiological predictors of success with medical treatment alone.

This single-center retrospective study included patients under 18 years old hospitalized for acute pharyngeal suppuration between January 1, 2015 and December 31, 2017. Patients were divided into three groups: group A received intravenous antibiotics alone; group B underwent surgery after 48 hours of appropriate antibiotic therapy because of persistent fever and/or clinical worsening and/or a collection persisting on follow-up imaging; and group C received surgery as first-line treatment together with intravenous antibiotics. There were 83 patients: 36 in group A, 12 in group B, and 35 in group C. The groups were compared for age, polymorphonuclear neutrophil counts, collection diameter measured as the largest diameter on imaging, duration of antibiotic therapy, time until fever resolved, and length of hospitalization.

A neck mass was present in 48.8% of cases and torticollis in 47.6%. No breathing difficulties were reported. Streptococcus pyogenes was the most frequently identified microorganism.

The average collection diameter was significantly larger in children receiving first-line surgery (group C) than in those receiving antibiotics alone (group A): 27.89 mm versus 18.73 mm, respectively (p = 0.0006). All patients who required surgery despite 48 hours of appropriate antibiotic therapy (group B) had collections at least 15 mm in diameter. There was no significant difference between the groups in length of hospitalization.

The authors concluded that medical treatment alone was associated with a high cure rate, mainly for collections with a small diameter. They recommended special attention to patients receiving first-line intravenous antibiotics alone when the collection diameter is at least 15 mm.