Clinical context (Diffuse neck soft-tissue infection (phlegmon) — often after tonsillopharyngitis, dental infection, sinusitis, or cervical lymphadenitis; distinguish from drainable abscess and deep space collections)
Dose is calculated using the amoxicillin component.
Max 875 mg/dose (amoxicillin) · Max 1750 mg/day · Duration: 10–14 days · Outpatient when stable, tolerating PO, no airway red flags — reassess at 24–48 h; admit if toxic, worsening, or unclear depth
• Imaging: neck ultrasound if superficial collection unclear; CT neck with IV contrast if deep space suspected, no improvement at 48 h, or pre-op planning — do not delay antibiotics for stable child.
• Do NOT manipulate neck aggressively; NPO if aspiration risk (dysphagia, drooling).
• Admit if: toxic appearance, dehydration, failed outpatient therapy, rapidly progressive swelling, or any airway red flag.
• Surgery/ENT consult when: abscess on imaging, fluctuance, airway concern, or no improvement at 24–48 h on appropriate antibiotics.
Dose is calculated using the ampicillin component.
Max 2000 mg/dose (ampicillin) · Max 8000 mg/day · Duration: 10–14 days · Preferred IV when admitted; step down to amoxicillin/clavulanate when improving
• Hospitalized child who cannot tolerate oral therapy or has moderate systemic illness without airway compromise.
• Step-down to oral amoxicillin/clavulanate when afebrile ≥24 h, improving, tolerating PO, and no progression on exam/imaging.
Enter weight on Kids to calculate doses
Clinical notes
• Standard pediatric empiric coverage: amoxicillin/clavulanate or ampicillin/sulbactam — oral anaerobes + S. aureus + GAS (AAP, ESPID).
• Early cervical phlegmon without drainable abscess or airway signs — antibiotics + close follow-up; escalate to Deep Neck Infection card if red flags develop.
• IV→PO switch when clinically improving; total course typically 10–14 days, guided by response and source control.
• AAP Red Book — Deep neck infections / cervical phlegmon (pediatric principles) (2024)
