Abcès rétro- et parapharyngés de l’enfant : facteurs prédictifs d’échec du traitement médical

Objective

To consider the predictive factors of failure after medical treatment (intravenous antibiotics) first initiated in children with retro- and parapharyngeal abscess, without life-threatening complications.

Patients and methods

Retrospective study between 1998 and 2006 of 45 children treated at the Nantes University Hospital for a retro- and paraphayngeal abscess.

Results

Median age was 3.8 years. Thirty (66%) patients required surgical management. Significant predictive factors of failure of initial medical therapy were: patients under 3 years of age, symptoms more than 3 days before intravenous antibiotic therapy, leukocyte count higher than 22,000 per millimeter cube, hypodensity diameter greater than 20 mm, and abscess demonstrated on CT scan. Previous antibiotic therapy at home was not significantly related to medical treatment failure. Broad-spectrum antibiotic therapy associations did not improve medical outcome.

Conclusion

The predictive factors of failure after initial medical therapy for retro- and/or parapharyngeal abscess in children are underlined; these factors help determine the clinical approach.