From the Research
Treatment of a pharyngeal tonsillar abscess should involve prompt surgical drainage and antibiotic therapy with penicillin G ± metronidazole as the first-line treatment, as recommended by the most recent and highest quality study 1. The primary treatment is incision and drainage of the abscess, which should be performed under local or general anesthesia depending on the size and location of the abscess. Following drainage, empiric antibiotic therapy should be initiated with coverage for common oropharyngeal pathogens including streptococci, staphylococci, and anaerobes. Some key points to consider in the treatment of pharyngeal tonsillar abscess include:
- The use of penicillin G ± metronidazole as the first-line antibiotic treatment, as it has been shown to be effective in managing parapharyngeal abscesses 1
- The importance of prompt surgical drainage to prevent complications such as airway obstruction or spread of infection
- The need for adequate pain management and hydration during recovery
- The use of warm salt water gargles to help with pain and promote healing
- The importance of monitoring for complications such as dehydration, spread of infection, or airway compromise
It is also worth noting that while some studies have suggested the use of other antibiotics, such as cefuroxime 1 or clindamycin 2, 3, the most recent and highest quality study recommends penicillin G ± metronidazole as the first-line treatment. Additionally, a systematic review of the role of penicillin versus penicillin plus metronidazole in the management of peritonsillar abscess found no evidence to suggest additional benefit with metronidazole 4.
Overall, the treatment of pharyngeal tonsillar abscess should prioritize prompt surgical drainage and antibiotic therapy with penicillin G ± metronidazole, with a focus on preventing complications and promoting recovery.