Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess : a prospective observational study
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:279 |
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| Enthalten in: |
European 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 - 279(2022), 4 vom: 11. Apr., Seite 2057-2067 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Klug, Tejs Ehlers [VerfasserIn] |
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| Links: |
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| Themen: |
140QMO216E |
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| Anmerkungen: |
Date Completed 21.03.2022 Date Revised 21.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00405-021-06962-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM327434651 |
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| 245 | 1 | 0 | |a Clinical evaluation of antibiotic regimens in patients with surgically verified parapharyngeal abscess |b a prospective observational study |
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| 500 | |a Date Revised 21.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a 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) | ||
| 520 | |a METHODS: Sixty adult patients with surgically verified PPA were prospectively enrolled at five Danish Ear-nose-throat departments | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Antibiotics | |
| 650 | 4 | |a Complications | |
| 650 | 4 | |a Evaluation | |
| 650 | 4 | |a Management | |
| 650 | 4 | |a Microbiology | |
| 650 | 4 | |a Parapharyngeal abscess | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 650 | 7 | |a Metronidazole |2 NLM | |
| 650 | 7 | |a 140QMO216E |2 NLM | |
| 700 | 1 | |a Andersen, Camilla |e verfasserin |4 aut | |
| 700 | 1 | |a Hahn, Pernille |e verfasserin |4 aut | |
| 700 | 1 | |a Danstrup, Christian Sander |e verfasserin |4 aut | |
| 700 | 1 | |a Petersen, Niels Krintel |e verfasserin |4 aut | |
| 700 | 1 | |a Mikkelsen, Sophie |e verfasserin |4 aut | |
| 700 | 1 | |a Døssing, Helle |e verfasserin |4 aut | |
| 700 | 1 | |a Christensen, Anne-Louise |e verfasserin |4 aut | |
| 700 | 1 | |a Rusan, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Kjeldsen, Anette |e verfasserin |4 aut | |
| 700 | 1 | |a Greve, Thomas |e verfasserin |4 aut | |
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