From the Guidelines
The treatment for a peritonsillar abscess (PTA) caused by Streptococcus (Strep) requires a dual approach of drainage and antibiotics, with penicillin being the first-line antibiotic treatment, as recommended by the Infectious Diseases Society of America 1.
Overview of Treatment
The treatment approach involves:
- Drainage of the abscess through needle aspiration or incision and drainage to provide immediate relief of symptoms and prevent further complications.
- Antibiotic therapy to target the causative Streptococcus organism.
Antibiotic Therapy
For patients without a penicillin allergy, the recommended antibiotic regimens include:
- Penicillin V, oral, with a dose of 250 mg twice daily or 3 times daily for children, and 250 mg 4 times daily or 500 mg twice daily for adolescents and adults, for a duration of 10 days 1.
- Amoxicillin, oral, with a dose of 50 mg/kg once daily (maximum 1000 mg) or 25 mg/kg (maximum 500 mg) twice daily, for a duration of 10 days 1.
Alternative Antibiotics for Penicillin-Allergic Patients
For patients with a penicillin allergy, alternative antibiotics include:
- Cephalexin, oral, with a dose of 20 mg/kg/dose twice daily (maximum 500 mg/dose), for a duration of 10 days 1.
- Clindamycin, oral, with a dose of 7 mg/kg/dose 3 times daily (maximum 300 mg/dose), for a duration of 10 days 1.
Importance of Accurate Diagnosis
Accurate diagnosis of streptococcal pharyngitis, followed by appropriate antimicrobial therapy, is crucial for preventing acute rheumatic fever, suppurative complications, and minimizing potential adverse effects of inappropriate antimicrobial therapy 1.
Additional Considerations
Pain management with acetaminophen or NSAIDs, adequate hydration, and a soft diet are essential supportive measures. Steroids like dexamethasone may help reduce inflammation and pain. This comprehensive approach is necessary to effectively treat the peritonsillar abscess and prevent complications.
From the FDA Drug Label
Abscesses usually require surgical drainage. The treatment for a peritonsillar abscess (PTA) caused by Streptococcus (Strep) is surgical drainage.
- Azithromycin may be used to treat Streptococcus pyogenes infections, but it is not the primary treatment for a peritonsillar abscess.
- The FDA drug label recommends penicillin as the usual drug of choice for Streptococcus pyogenes infections, but it does not specifically address the treatment of peritonsillar abscesses caused by Streptococcus 2. Note that antibiotic therapy may be initiated before surgical drainage, but the primary treatment is surgical intervention. 2
From the Research
Treatment Overview
The treatment for a peritonsillar abscess (PTA) caused by Streptococcus (Strep) typically involves a combination of aspiration or surgical drainage, followed by appropriate antibiotic therapy.
Aspiration and Drainage
- Needle aspiration is considered the gold standard for diagnosis and treatment of peritonsillar abscess 3, 4, 5.
- Surgical drainage may be necessary in advanced cases or if needle aspiration is unsuccessful 3, 4.
Antibiotic Therapy
- Penicillin is effective against Streptococcus pyogenes, a common cause of peritonsillar abscess 6, 7.
- Other antibiotics such as clindamycin, cephalosporins, or metronidazole may also be used, especially if the infection is caused by multiple organisms or if the patient is allergic to penicillin 3, 7.
- A combination of penicillin and metronidazole is recommended to cover both aerobic and anaerobic bacteria 7.