What is the treatment for a peritonsillar abscess (PTA) associated with tonsillitis?

From the Guidelines

Treatment for a peritonsillar abscess (PTA) associated with tonsillitis typically involves antibiotics and drainage of the abscess, with the standard antibiotic regimen including penicillin or clindamycin for 10-14 days. The abscess usually requires drainage through needle aspiration or incision and drainage performed by a healthcare provider. While waiting for medical care, patients should maintain hydration, use salt water gargles every 2-3 hours, and take acetaminophen or ibuprofen for pain and fever.

Key Considerations

• The condition results from bacterial infection, typically streptococcal, that progresses from tonsillitis to form a collection of pus between the tonsil and surrounding tissue 1.
• Without proper treatment, the infection can spread to deeper tissues of the neck or bloodstream, making professional medical evaluation essential.
• Warning signs requiring immediate medical attention include difficulty breathing, inability to swallow, or severe pain.

Antibiotic Regimen

• The standard antibiotic regimen includes penicillin (such as amoxicillin-clavulanate 875/125 mg twice daily) or clindamycin 300-450 mg four times daily for patients with penicillin allergies, for 10-14 days 1.
• It is essential to note that the choice of antibiotic may vary depending on the severity of the infection, patient's medical history, and potential allergies.

Drainage and Supportive Care

• The abscess usually requires drainage through needle aspiration or incision and drainage performed by a healthcare provider.
• Patients should maintain hydration, use salt water gargles (1/2 teaspoon salt in 8 oz warm water) every 2-3 hours, and take acetaminophen or ibuprofen for pain and fever.
• Cultures from abscesses and other purulent infections 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

Treatment for Peritonsillar Abscess (PTA) Associated with Tonsillitis

The treatment for peritonsillar abscess (PTA) associated with tonsillitis typically involves a combination of surgical drainage and antibiotic therapy.

• Surgical drainage is often performed through needle aspiration or incision and drainage to remove the abscess material 2, 3, 4.
• Antibiotic therapy is essential to treat the underlying bacterial infection.
• The choice of antibiotics is crucial, and studies suggest that penicillin and metronidazole are effective against both aerobic and anaerobic bacteria, which are commonly found in peritonsillar abscesses 2, 3.
• In some cases, broad-spectrum antibiotics such as clindamycin may be necessary if the initial treatment is ineffective 3.
• The duration of antibiotic therapy is typically 10 days, and it is essential to complete the full course to prevent poststreptococcal sequelae 5.
• Other antibiotics such as cephalosporins, macrolides, and amoxicillin-clavulanate may also be effective in eradicating the infection, especially in patients who have failed previous penicillin therapy 6.

Antibiotic Regimens

Some recommended antibiotic regimens for the treatment of peritonsillar abscess include:

• Penicillin and metronidazole 2, 3
• Cefuroxime and metronidazole 5
• Amoxicillin-clavulanic acid 5
• Clindamycin (as a broad-spectrum alternative) 3

Important Considerations

• Bacteriologic studies are not necessary on initial presentation, but it is essential to consider infection with anaerobes 2, 3.
• The choice of antibiotic should be based on the severity of the infection and the patient's medical history 4.
• Completing the full course of antibiotic therapy is crucial to prevent poststreptococcal sequelae 5.