From the Research
The recommended course of action for this 10-year-old patient is to complete the full course of oral antibiotics, which typically requires an additional week of treatment. The patient should continue taking the prescribed oral antibiotic (commonly amoxicillin-clavulanate at 45 mg/kg/day divided twice daily, or clindamycin 30 mg/kg/day divided three times daily if penicillin-allergic) for a total duration of 14 days, as suggested by the most recent and highest quality study 1. Despite clinical improvement after one week, prematurely stopping antibiotics may lead to recurrence of infection or development of antibiotic resistance. Tonsillar abscesses require complete eradication of the causative bacteria, which are typically mixed aerobic and anaerobic organisms including Group A Streptococcus, Staphylococcus aureus, and anaerobes, as noted in the study 2. Parents should ensure the child takes all doses as prescribed, even if symptoms have resolved. They should also maintain adequate hydration and pain control with acetaminophen or ibuprofen as needed. A follow-up appointment should be scheduled to confirm complete resolution of the infection and to assess whether further evaluation by an otolaryngologist is necessary to consider tonsillectomy if this is a recurrent issue, as recommended in the study 1.
Some key points to consider:
- The patient has already shown improvement with IV antibiotics, but oral antibiotics are necessary to complete the treatment course.
- The most common pathogens involved in tonsillar abscesses include Group A Streptococcus, Staphylococcus aureus, and anaerobes, as identified in the study 2.
- Completing the full course of antibiotics is crucial to prevent recurrence and antibiotic resistance.
- Pain control and hydration are essential for the patient's comfort and recovery.
- A follow-up appointment is necessary to assess the patient's progress and determine if further evaluation or treatment is needed.
It is essential to prioritize the patient's morbidity, mortality, and quality of life when making treatment decisions, and in this case, completing the full course of antibiotics is the best course of action, as supported by the study 1.