Clinical characteristics and efficacy of antimicrobial treatment in pediatric parapharyngeal abscess without surgical intervention

Parapharyngeal abscess (PPA) is a type of deep neck abscess. Due to its nonspecific clinical manifestations, early diagnosis of PPA is often challenging. Additionally, its anatomical location complicates decisions regarding the necessity of surgical intervention. Few studies have documented successful antibiotic treatment for PPA without surgical intervention. In Japan, the clinical course of pediatric patients with PPA managed exclusively with antibiotics remains unclear. This study investigated the clinical characteristics and effectiveness of antimicrobial therapy in children with PPA. In this single-center case series, we retrospectively reviewed the charts of patients diagnosed with PPA via contrast-enhanced computed tomography and treated at our hospital between October 2023 and October 2024. Data on patients’ backgrounds, clinical symptoms, laboratory results, imaging, treatments, and outcomes were collected. Ten patients with PPA were included. None experienced complications such as sepsis or airway obstruction. Fever was the most common symptom (100 %), followed by neck pain (90 %) and neck immobility (80 %). All patients were treated with antibiotics without surgical intervention. Fever resolved within 3 days in eight patients but persisted for 21 days in one patient with an abscess >25 mm. Antimicrobial therapy without surgical intervention might be safe and effective for patients with PPA who lack life-threatening complications.