From the Research
Peritonsillar abscesses typically require both antibiotics and drainage (I&D) for optimal treatment, but in select cases, antibiotics alone may be attempted, especially with high-dose penicillin or amoxicillin-clavulanate, as suggested by 1 and 2. While antibiotics alone may be attempted in very early or mild cases, most peritonsillar abscesses will not resolve with antibiotics alone and will require drainage. The reason drainage is typically required is that antibiotics penetrate poorly into the abscess cavity due to the thick wall of the abscess and the presence of purulent material that neutralizes antibiotic activity. Some key points to consider when deciding on treatment include:
- The severity of symptoms: patients with severe symptoms, inability to swallow, respiratory compromise, or systemic toxicity should always undergo immediate drainage rather than antibiotic therapy alone.
- The effectiveness of antibiotic therapy: high-dose penicillin (such as penicillin V 500 mg orally four times daily), amoxicillin-clavulanate (875/125 mg twice daily), or clindamycin (300-450 mg four times daily) for patients with penicillin allergy may be appropriate for 10-14 days, as shown in 3 and 2.
- The need for close monitoring: patients should be closely monitored for clinical improvement within 24-48 hours, and if symptoms worsen or fail to improve, drainage becomes necessary. Additionally, drainage provides immediate symptom relief by reducing pressure and pain, and can be performed through needle aspiration or incision and drainage, as discussed in 4 and 5. It's also important to note that the choice of antibiotic therapy may depend on the suspected or confirmed causative organisms, and the patient's allergy history, as mentioned in 3 and 1. In general, the treatment of peritonsillar abscess should be individualized based on the patient's specific condition and medical history, and should always prioritize the patient's morbidity, mortality, and quality of life, as suggested by the most recent and highest quality study, 2.