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 most recent and highest quality study 1 provides guidelines for the diagnosis and management of skin and soft tissue infections, including abscesses. Although this study does not specifically address peritonsillar abscesses, it emphasizes the importance of drainage and antibiotic therapy for abscesses in general.
Key Considerations
- Drainage of the abscess is usually performed by an otolaryngologist through needle aspiration or incision and drainage.
- Pain management with acetaminophen or ibuprofen is recommended, along with adequate hydration and rest.
- Warm salt water gargles (1/2 teaspoon salt in 8 oz warm water) several times daily can provide symptomatic relief.
- Patients should seek immediate medical care if they experience difficulty breathing, swallowing, or opening their mouth, as these may indicate a spreading infection.
Antibiotic Therapy
- 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.
- The choice of antibiotic should be guided by the suspected causative bacteria, typically streptococcal species.
Additional Recommendations
- 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.
- Consideration should be given to the potential for recurrent abscesses, and patients should be evaluated for underlying conditions that may contribute to recurrent infections 1.
From the Research
Treatment for Peritonsillar Abscess (PTA)
The treatment for peritonsillar abscess (PTA) associated with tonsillitis typically involves a combination of surgical drainage and antibiotic therapy.
- Surgical drainage can be performed through needle aspiration or incision and drainage 2, 3, 4.
- Antibiotic therapy is usually started after surgical drainage, with the goal of covering both aerobic and anaerobic bacteria 2, 3, 4, 5.
Antibiotic Regimens
The choice of antibiotic regimen may vary, but some common options include:
- Penicillin and metronidazole 2, 3, 4
- Benzylpenicillin and metronidazole 4
- Co-amoxiclav and metronidazole 4
- Cefuroxime and metronidazole 6
Importance of Anaerobic Coverage
Anaerobic bacteria are often present in peritonsillar abscesses, making it important to include anaerobic coverage in the antibiotic regimen 2, 3, 4.
Duration of Antibiotic Therapy
The duration of antibiotic therapy may vary, but it is typically continued for 7-10 days after surgical drainage 4, 6.