title: Antibiotic therapy for pediatric deep neck abscesses: a systematic review.
abstract: OBJECTIVE
  To evaluate the current evidence regarding the safety and efficacy of medical management for deep neck abscesses in children.
  
  
  METHODS
  Pubmed and Embase databases accessed 3/27/2012.
  
  
  METHODS
  An a priori protocol defining inclusion and exclusion criteria was developed to identify all articles addressing medical therapy of pediatric deep neck abscesses where details regarding diagnostic criteria, specifics of medical therapy and definitions of failure were presented. The search included electronic databases to identify candidate articles as well as a manual crosscheck of references. The level of evidence was assessed and data extracted by three authors independently. Data were pooled using a random effects model due to significant study heterogeneity.
  
  
  RESULTS
  Eight articles met inclusion criteria. The overall level of evidence was grade C. There was significant heterogeneity among the studies (I(2)=98.8%; p<.001). However, each article uniformly presented cases suggesting that medical therapy may be a viable alternative to surgical drainage in some patients. The pooled success rate of medical therapy in avoiding surgical drainage in children with deep neck infections was 0.517 (95%CI: 0.335, 0.700). When patients taken immediately to surgery were excluded and patients were placed on author defined medical protocols, the success rate increased to 0.951 (95%CI: 0.851, 1.051). Subgroup analysis by duration of intravenous antibiotic trial greater than 48h demonstrated a pooled success rate of 0.740 (95%CI: 0.527, 0.953).
  
  
  CONCLUSIONS
  The current literature suggests medical management may be a safe alternative to surgical drainage of deep neck abscesses in children. However, the level of evidence lacks strength and further investigation is warranted.
authors.affiliation: Naval Medical Center San Diego, Department of Anatomic Pathology, San Diego, CA 92134, United States.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Carbone
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Capra
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brigger
mesh_terms: D000038:Abscess / Q000188:drug therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D010608:Pharyngeal Diseases / Q000188:drug therapy*; D017703:Retropharyngeal Abscess / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents