Corticosteroids in the Treatment of Pediatric Retropharyngeal and Parapharyngeal Abscesses

Pediatrics. 2021 Nov;148(5):e2020037010. doi: 10.1542/peds.2020-037010. Epub 2021 Oct 25.


Background and objectives: Treatment of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs) includes antibiotics, with possible surgical drainage. Although corticosteroids may decrease inflammation, their role in the management of RPAs and PPAs is unclear. We evaluated the association of corticosteroid administration as part of initial medical management on drainage rates and length of stay for children admitted with RPAs and PPAs.

Methods: We conducted a retrospective study using administrative data of children aged 2 months to 8 years discharged with RPAs and PPAs from 2016 to 2019. Exposure was defined as systemic corticosteroids administered as part of initial management. Primary outcome was surgical drainage. Bivariate comparisons were made between patients in the corticosteroid and noncorticosteroid groups by using Wilcoxon rank or χ2 tests. Outcomes were modeled by using generalized linear mixed-effects models.

Results: Of the 2259 patients with RPAs and PPAs, 1677 (74.2%) were in the noncorticosteroid group and 582 (25.8%) were in the corticosteroid group. There were no significant differences in age, sex, or insurance status. There was a lower rate of drainage in the corticosteroid cohort (odds ratio: 0.28; confidence interval: 0.22-0.36). Patients in this group were more likely to have repeat computed tomography imaging performed, had lower hospital costs, and were less likely to have opioid medications administered. The corticosteroid cohort had a higher 7-day emergency department revisit rate, but there was no difference in length of stay (rate ratio 0.97; confidence interval: 0.92-1.02).

Conclusions: Corticosteroids were associated with lower odds of surgical drainage among children with RPAs and PPAs.

Publication types

  • Multicenter Study

MeSH terms

  • Abscess / diagnosis
  • Abscess / drug therapy*
  • Abscess / surgery*
  • Adrenal Cortex Hormones / therapeutic use*
  • Age Factors
  • Anti-Bacterial Agents / therapeutic use
  • Child
  • Child, Preschool
  • Combined Modality Therapy / methods
  • Drainage / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospital Costs
  • Humans
  • Infant
  • Insurance Coverage
  • Length of Stay
  • Male
  • Patient Readmission / statistics & numerical data
  • Pharyngeal Diseases / diagnosis
  • Pharyngeal Diseases / drug therapy*
  • Pharyngeal Diseases / surgery*
  • Retropharyngeal Abscess / diagnosis
  • Retropharyngeal Abscess / drug therapy
  • Retropharyngeal Abscess / surgery
  • Retrospective Studies
  • Sex Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents