Treatment of non-tuberculous mycobacterial cervicofacial lymphadenitis in children: critical appraisal of the literature

Background: Surgical excision has historically been the treatment of choice for non‐tuberculous mycobacterial cervicofacial lymphadenitis. Emerging data suggests antibiotic treatment alone could be an attractive alternative to surgery. We questioned (1) what treatment offers best cure rates in children with this condition and (2) the evidence for antibiotic treatment alone. Type of review: Structured literature search according to the Evidence Based Medicine guidelines. Search strategy/methods: A structured search was conducted in PubMed, Embase and the Cochrane Library from 1966 up to November 2007. Relevant papers were critically appraised. Results: Six papers were included, one of which was a randomised controlled clinical trial (RCT). In general, treatment sequencing was not consistent. Surgery and medical treatment were often used in combination, resulting in high overall cure rates. In the RCT surgery and antibiotic treatment were compared as single modalities. The outcome of surgery was far superior (96%versus 66% cure rate, respectively). Other studies indicated that substantial cure rates (up to 67%) were achieved with medical management alone, but failed to identify factors predicting response. Conclusion: Surgical excision still is the backbone in the management of cervicofacial non‐tuberculous mycobacterial lymphadenitis, although a considerable number of children can be cured with antibiotics alone or combined modality treatment. To date it is unclear which subset of patients can benefit from antibiotic treatment only.