Any patient with impeding airway obstruction should be referred early to an experienced clinician for definitive airway management
Antibiotics for Group A streptococcal pharyngitis:
1st line oral agent:
Penicillin (Phenoxymethyl)
< 10 years: 250mg orally BD for 10 days
> 10 years: 500mg orally BD for 10 days
2nd line oral agent:
Cephalexin 20 mg/kg orally BD (max 1 g per day) for 10 days
Anaphylaxis to beta-lactam antibiotics (penicillin and cephalosporins):
Roxithromycin 4 mg/kg (max 150mg) orally BD for 10 days
Unable to tolerate oral medication/poor compliance
Benzathine Pencillin G
<27 kg: 600,000 U IM
≥27 kg: 1,200,000 U IM
OR
Benzylpenicillin 60 mg/kg (2 g) IV 6 hourly
Analgesics:
1) Analgesia - see Analgesia CPG
2) Corticosteroids
Consider in patients with severe pain unresponsive to simple analgesia.
Dexamethasone 0.15 mg/kg (max 10 mg) PO/IV/IM as a single dose OR
Prednisolone 1 mg/kg PO (max 50 mg) as a single dose
This can be repeated the next day.
When to admit/consider transfers to a tertiary centre
- Suspected upper airway obstruction
- Systemically unwell patients
- Evidence of acute complications e.g. abscess formation, upper airway obstruction
- Significant comorbidity e.g. immunosuppression (after discussion with relevant treating team)
Disease
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Symptoms/Signs
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Management
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Peritonsilllar abscess (Quinsy)
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Severe sore throat (often unilateral)
“Hot “ potato voice
Difficulty swallowing saliva (pooling/drooling)
Trismus
Neck swelling
Referred ear pain
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Antibiotics:
- Benzylpenicillin 60 mg/kg
(max 2 g) IV 6 hourly- Metronidazole 15mg/kg (max 500 mg)
IV stat then 7.5 mg/kg IV 8 hourly
Refer to ENT for surgical drainage
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Infectious mononucleosis (EBV)
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Fever
Protracted illness
Cervical lymphadenopathy
Fatigue and malaise
Variable hepatosplenomegaly
Amoxycillin-induced rash
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Analgesia
Hydration
Consider corticosteroids
Consider admission if unable to tolerate oral fluids
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Epiglottitis/Bacterial Tracheitis
(more likely if unimmunised against H. influenzae)
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Abrupt onset
Respiratory distress
Absent cough with low pitched stridor
Muffled/hoarse voice
Tripod/sniffing position
Drooling
Fever
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Maintain position of comfort with parents present
Defer invasive examinations/ procedures (IV) or imaging (lateral neck x-ray) in patients with severe respiratory distress due to risk of precipitating respiratory arrest
Early PICU/anaesthetic review
Antibiotics: Ceftriaxone 50 mg/kg (max 2 g) IV 12 hourly
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Retropharyngeal abscess/Lateral pharyngeal abscess
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Retropharyngeal abscess:
Respiratory distress/stridor
Dysphagia, odynophagia, drooling
Torticollis
Muffled voice
Neck mass
Trismus
Chest pain
Lateral pharyngeal abscess:
Above including trismus and
swelling below the mandible
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Lateral neck x-ray initially: A normal x-ray does not exclude the diagnosis.
CT with IV contrast is the imaging modality of choice. This should be performed in a setting where advanced airway management is able to be performed.
Antibiotics: Timentin 50 mg/kg (max 3 g) IV 6 hourly
Refer to ENT for surgical drainage
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For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.
Information specific to RCH
Any patient with suspected airway obstruction should be referred to PICU x55211
All patients requiring admission should be admitted under a general medical unit with ENT consultation.
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