Serious deep neck space infections

Critically ill patients and/or immunocompromised: Discuss urgently with Micro/ID who may recommend higher doses or broader spectrum antibiotics e.g.unknown aetiology: amoxicillin 2g iv tds AND gentamicin* 5mg/kg iv (Gentamicin is for maximum of 3 days) AND metronidazole 400mg po tds. Immunocompromised/neutropaenic: piperacillin-tazobactam 4.5g iv tds or qds

*Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.

•  Includes:
  • Epiglottits/supraglottitis
  • Lemierre’s syndrome
  • Foreign body impaction
  • Ludwig’s angina
  • Retro- or para- pharyngeal abscess
  • Cavernous sinus thrombosis
  • Surgical site infection after head and neck cancer surgery

Spread of infection to mediastinum, carotid sheath and jugular vein should be considered. If septic thrombophlebitis of the jugular vein is present then metastatic pulmonary abscesses may occur.

Recommended management:

• Urgent imaging of neck, chest and mediastinum.
• Drainage of any collections (surgically or radiologically guided) with sampling of infected tissues for microscopy and culture.
• Antibiotic therapy listed below is empiric. Treatment should always be tailored to culture and sensitivity.
• Consult Micro/ID and ENT or MaxFax

For treatment for more superficial infections (e.g epiglottits / supraglottitis): 7 to 10 days may be sufficient.

For deeper infections treatment: May be 4-6 weeks as guided by Micro/ID, with first 1-2 weeks often given intravenously.