From the Guidelines
The best empiric antibiotic regimen for a tonsillar abscess is clindamycin 300-450 mg orally four times daily for 10-14 days, as it provides coverage against the common causative organisms, including Group A Streptococcus, Staphylococcus aureus, and anaerobic bacteria. This recommendation is based on the guidelines provided by the Infectious Diseases Society of America 1. For patients with penicillin allergy, clindamycin is an appropriate alternative. In more severe cases requiring hospitalization, clindamycin 600-900 mg IV every 8 hours may be used.
Key Considerations
- The choice of antibiotic should target the common causative organisms in tonsillar abscesses, which include Group A Streptococcus, Staphylococcus aureus, and anaerobic bacteria such as Fusobacterium and Bacteroides species.
- Clindamycin is effective against these organisms and is recommended for empirical therapy for CA-MRSA 1.
- Incision and drainage is the primary treatment for cutaneous abscesses, including tonsillar abscesses, and antibiotic therapy is recommended for abscesses associated with severe or extensive disease, signs and symptoms of systemic illness, or lack of response to incision and drainage alone 1.
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
Additional Recommendations
- Patients should also be advised to maintain adequate hydration, use analgesics for pain control, and seek immediate medical attention if they develop difficulty breathing, inability to swallow, or worsening symptoms despite treatment.
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1.
From the Research
Empiric Antibiotics for Tonsillar Abscess
- The choice of empiric antibiotics for tonsillar abscess should be based on the common organisms associated with the infection and their antibiotic sensitivity pattern 2.
- Streptococcus pyogenes and Staphylococcus aureus are commonly associated with peritonsillar abscess, with Streptococcus pyogenes being sensitive to penicillin and Staphylococcus aureus being resistant to it 2.
- Cloxacillin, ciprofloxacin, and ceftazidime have been found to be effective against both Streptococcus pyogenes and Staphylococcus aureus 2.
- Amoxicillin-sulbactam is a broad-spectrum antibiotic that is effective against a variety of pathogens, including Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus, making it a potential option for empiric treatment of tonsillar abscess 3.
Treatment Approaches
- Intravenous antibiotics with needle aspiration have been suggested as the primary treatment for acute intratonsillar abscess 4, 5.
- Incision and drainage with antibiotics may be reserved for cases unresponsive to initial measures, and tonsillectomy may be recommended for recurrent cases 4.
- Immediate tonsillectomy has been proposed as a safe and effective treatment alternative to conventional incision and drainage for peritonsillar abscess 6.