What is the management of a peritonsillar abscess (PTA)?

From the Guidelines

Management of a peritonsillar abscess (PTA) requires prompt treatment with antibiotics and drainage, with the goal of preventing complications such as airway obstruction, extension to deep neck spaces, or sepsis. The initial management includes empiric antibiotic therapy with penicillin (such as amoxicillin-clavulanate 875/125 mg twice daily) or clindamycin 300-450 mg four times daily for penicillin-allergic patients, as recommended by the Infectious Diseases Society of America 1. Key considerations in the management of PTA include:

• Surgical drainage, which can be performed via needle aspiration or incision and drainage under local anesthesia, as outlined in the 2018 WSES/SIS-E consensus conference recommendations for the management of skin and soft-tissue infections 1
• Hospitalization for intravenous antibiotics (ampicillin-sulbactam 3 g every 6 hours or clindamycin 600-900 mg every 8 hours) if patients have severe symptoms, inability to tolerate oral intake, or systemic toxicity
• Pain management with acetaminophen or NSAIDs, and steroids (dexamethasone 10 mg IV followed by 4 mg every 6 hours) to reduce inflammation
• Hydration and nutritional support during recovery
• Consideration of surgical tonsillectomy after the acute infection resolves, particularly for recurrent cases It is essential to note that the management of PTA should prioritize preventing complications and promoting recovery, with a focus on individualized patient care and adherence to evidence-based guidelines 1.

From the Research

Management of Peritonsillar Abscess (PTA)

The management of PTA typically involves a combination of diagnostic and therapeutic approaches.

• Diagnosis: Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis of PTA 2.
• Treatment: Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess 2.
• Antibiotic therapy: Appropriate antibiotic treatment depends on the common organisms associated with infection and their antibiotic sensitivity pattern in the local scenario 3.
  • Penicillin is effective for Streptococcus pyogenes, whereas Staphylococcus aureus is resistant to it 3.
  • Cloxacillin is effective for Staphylococcus aureus 3.
  • Ciprofloxacin and Ceftazidime are effective for both Streptococcus pyogenes and Staphylococcus aureus 3.
• Corticosteroids: The use of systemic corticosteroids (SCSs) in PTA may result in less pain at 24 hours when compared to placebo, without any serious side effects 4.
• Surgical intervention: Incision and drainage or immediate tonsillectomy may be required in advanced cases 2.

Treatment Strategies

Different treatment strategies have been reported, including:

• Needle aspiration and antibiotic therapy 5, 6.
• Incision and drainage 6, 2.
• Tonsillectomy 6, 2.
• Combination of aspiration, incision, and drainage, and antibiotic therapy 3, 2.