of the ear and throat are the most common source Streptococcus species are the causative agents in the majority of bacterial infections of the head and neck Infected lymph nodes usually contain the same organisms as the primary infection Treatment with amoxicillin or penicillin usually clears the infection and causes regression of the enlarged lymph nodes Culture of the nasopharynx, throat, or aspirate of the cervical node can assist the physician in the choice of antimicrobial agents Although most children respond to oral antibiotics, a small group of children develop nodes that progress to suppurative cervical adenitis that usually requires hospitalization A recent study of children hospitalized with cervical adenitis has shown a predominance of S aureus as the causative agent (63% of positive cultures were S aureus and 22% were group A streptococci, respectively) Of the staphylococcal infections, 27% were MRSA and all of these were sensitive to clindamycin and trimethoprim-sulfamethoxazole, 63% were sensitive to ciprofloxacin, and 25% to erythromycin Of the methicillin-sensitive S aureus isolates, 100%, 85%, and 82% were sensitive to trimethoprim-sulfamethoxazole, clindamycin, and ciprofloxacin, respectively, though prevalence and sensitivities of MRSA will vary regionally The high incidence of staphylococci in these hospitalized patients may occur because they have not responded to oral antimicrobials effective against the more commonly occurring Streptococcus species Therefore, if cervical adenitis has not responded to the primary antimicrobial treatment, agents should be added that are effective against S aureus (as well as other Streptococcus species) Clinical Indications for Discharge or Admission The majority of patients with lymphadenitis can be managed as outpatients on oral antibiotics A child who has demonstrated rapid enlargement of cervical nodes, poor response to oral antimicrobials, cellulitis of the overlying skin, abscess formation, or signs of toxicity (high fever, malaise, dehydration) should be admitted to the hospital for treatment with IV fluids and antimicrobials Surgical consultation should be obtained in the management of these complicated cases in which needle aspiration, incision and drainage, or biopsy (for possible neoplasm) may be required POSTTONSILLECTOMY HEMORRHAGE Goals of Treatment