Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
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).
References
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
13 June 2012
Fleur Porter
SHO Oral and Maxillofacial Surgery
Arun Majumdar - Consultant Oral and Maxillofacial Surgeon. Beds, Herts and Bucks Maxillofacial Network
Re: A child with neck swelling
Dear Sir/Madam
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).
References
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