A child with neck swellingBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3171 (Published 08 May 2012) Cite this as: BMJ 2012;344:e3171
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We read with interest the 10 minute consultation on a child with neck swelling.
We would like to congratulate the authors on highlighting the assessment of cervical lymphadenopathy which is a common problem in children. We are however surprised at the omission of ultrasound plus/minus FNA which is an invaluable diagnostic tool (1) in this group of patients and we would recommend its use in primary care.
The current literature recommends that the treatment of acute bacterial cervical lymphadenitis without a known primary source should provide adequate coverage for both Staphylococcus aureus and group A beta haemolytic streptococci the causative organisms in 40-80% of cases (2). The authors’ recommendation of phenoxymethyl penicillin is not supported in the current literature. In our clinical practice, macrolides such as Clarithromycin are much more effective.
To conclude for the benefit of colleagues in primary care we would like to stress the importance of prompt and appropriate surgical referral recognising the fact that 10% of the above group require incision and drainage despite medical treatment (3).
1. Niedzielska G, Kotowski M, Niedzielski A, Dybiec E, Wieczorek P. Cervical lymphadenopathy in children--incidence and diagnostic management. International Journal of Pediatric Otorhinolaryngology 2007 Jan; 71(1):51-6. Epub 2006 Nov 9.
2. Leung AK, Davies HD. Cervical lymphadenitis: etiology, diagnosis, and management. Current Infectious Disease Reports 2009 May; 11(3):183-9.
3. Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatrics in review / American Academy of Pediatrics 2000 Dec; 21(12):399-405.
Competing interests: No competing interests