From the Research
The recommended treatment for a tonsillar abscess is drainage of the abscess combined with antibiotic therapy, as this approach is effective in reducing morbidity, mortality, and improving quality of life. Drainage can be performed through needle aspiration or surgical incision and drainage, which provides immediate relief by removing the collection of pus. Following drainage, antibiotics are prescribed to eliminate the remaining infection. Common antibiotic regimens include amoxicillin-clavulanate (875/125 mg twice daily for 10-14 days), clindamycin (300-450 mg four times daily for 10 days) for penicillin-allergic patients, or a combination of a penicillin with metronidazole to cover anaerobic bacteria, as suggested by 1.
Key considerations in the treatment of tonsillar abscess include:
- The use of antibiotics effective against group A streptococcus and oral anaerobes as first-line therapy, as noted in 1
- The potential benefits of corticosteroids in reducing symptoms and speeding recovery, as indicated by 2
- The importance of maintaining hydration and managing pain with acetaminophen or NSAIDs, as part of supportive care
- The need for hospitalization in severe cases with airway compromise for intravenous antibiotics and close monitoring, to prevent complications such as airway obstruction or extension of infection into deep neck tissues, as highlighted in 1
In terms of specific antibiotic choices, the most recent and highest quality study 1 suggests that antibiotics effective against group A streptococcus and oral anaerobes should be used as first-line therapy. This approach is supported by the fact that tonsillar abscesses are typically polymicrobial infections involving both aerobic and anaerobic bacteria, and physical drainage is essential as antibiotics alone may not penetrate the abscess cavity effectively.
Overall, the treatment of tonsillar abscess should prioritize drainage and antibiotic therapy, with consideration of supportive care and potential complications, as outlined in 1, to optimize outcomes in terms of morbidity, mortality, and quality of life.