Antibiotics
Antibiotic therapy is empirical, it is given until culture and sensitivity results are obtained. The empirical therapy should be effective against both aerobic and anaerobic bacteria species commonly involved in Ludwigs Angina. Only when culture and sensitivity results return should therapy be tailored to the specific requirements of the patient.Empirical coverage should consist of either a penicillin with a B-lactamase inhibitor such as amoxicillin/ticarcillin with clavulanic acid or a Beta-lactamase resistant antibiotic such as cefoxitin, cefuroxime, imipenem or meropenem. This should be given in combination with a drug effective against anaerobes such as clindamycin or metronidazole. Parenteral antibiotics are suggested until the patient is no longer febrile for at least 48 hours. Oral therapy can then commence to last for 2 weeks, with amoxicillin with clavulanic acid, clindamycin, ciprofloxacin, trimethoprim-sulfamethoxazole, or metronidazole. Incision and drainage
Surgical incision and drainage are the main methods in managing severe and complicated deep neck infections that fail to respond to medical management within 48 hours. It is indicated in cases of:Airway compromise
Septicaemia
Deteriorating condition
Descending infection
Diabetes mellitus
Palpable or radiographic evidence of abscess formation
Bilateral submandibular incisions should be carried out in addition to a midline submental incision. Access to the supramylohyoid spaces can be gained by blunt dissection through the mylohyoid muscle from below. Penrose drains are recommended in both supramylohyoid and inframylohyoid spaces bilaterally. In addition, through and through drains from the submandibular space to the submental space on both sides should be placed as well. The incision and drainage process is completed with the debridement of necrotic tissue and thorough irrigation.
It is necessary to mark drains in order to identify their location. They should be sutured with loops as well so it will be possible to advance them without re-anaesthetizing the patient while drains are re-sutured to the skin. An absorbent dressing is then applied. A bandnet dressing retainer can be constructed so as to prevent the use of tape. Other things to consider
Nutritional support
Adequate nutrition and hydration support is essential in any patient following surgery, particularly young children. In this case, pain and swelling in the neck region would usually cause difficulties in eating or swallowing, hence reducing patients food and fluid intake. Patients must therefore be well-nourished and hydrated to promote wound healing and to fight off infection. Post-operative care
Extubation, which is the removal of endotracheal tube to liberate the patient from mechanical ventilation, should only be done when the patients airway is proved to be patent, allowing adequate breathing. This is indicated by a decrease in swelling and patients capability of breathing adequately around an uncuffed endotracheal tube with the lumen blocked.During the hospital stay, patients condition will be closely monitored by:

carrying out cultures and sensitivity tests to decide if any changes need to be made to patients antibiotic course
observing for signs of further infection or sepsis including fevers, hypotension, and tachycardia
monitoring patients white blood cell count - a decrease implies effective and sufficient drainage
repeating CT scans to prove patients restored health status or if infection extends, the anatomical areas that are affected.