What is the treatment for a peritonsillar abscess?

Treatment of Peritonsillar Abscess

The definitive treatment for peritonsillar abscess includes drainage of the abscess (via needle aspiration or incision and drainage) combined with antibiotic therapy effective against group A streptococcus and oral anaerobes. 1, 2

Diagnosis

• Typical presentation includes:
  • Fever
  • Severe throat pain
  • Dysphagia (difficulty swallowing)
  • Trismus (limited mouth opening)
  • "Hot potato" voice
  • Unilateral peritonsillar swelling with deviation of the uvula

Treatment Algorithm

Step 1: Drainage Procedure

Two main options exist for drainage:

1. Needle Aspiration

   • Less invasive, can be performed in outpatient setting
   • May be less painful during the procedure 3
   • Higher recurrence rate compared to incision and drainage 3

2. Incision and Drainage

   • More definitive drainage
   • Lower recurrence rate than needle aspiration 3
   • May cause more procedural pain 3

Step 2: Antibiotic Therapy

• Administer broad-spectrum antibiotics covering:
  • Group A streptococcus
  • Oral anaerobes (Bacteroides, Fusobacterium)
  • Common antibiotic choices include:
    • Amoxicillin-clavulanate
    • Clindamycin
    • Penicillin plus metronidazole

Step 3: Supportive Care

• Adequate hydration
• Pain control
• Consider corticosteroids to reduce symptoms and speed recovery 2

Step 4: Follow-up

• Clinical reassessment within 24-48 hours to ensure:
  • Resolution of fever
  • Improvement in pain and trismus
  • Improved ability to swallow 1

Special Considerations

Immediate Tonsillectomy

Consider immediate tonsillectomy in specific situations:

• Recurrent peritonsillar abscess (history of >1 episode) 1
• Bilateral peritonsillar abscesses 1
• Cases where drainage is difficult 1
• Immediate tonsillectomy has been shown to be safe and effective in selected cases 4

Interval Tonsillectomy

Consider tonsillectomy after resolution of acute infection in patients with:

• History of multiple peritonsillar abscesses 1

Potential Complications

• Airway obstruction
• Aspiration
• Extension of infection into deep neck tissues
• Dehydration
• Post-procedure bleeding (rare, reported in approximately 3.6% of cases) 4

Pitfalls to Avoid

1. Delaying drainage in patients with significant symptoms
2. Inadequate antibiotic coverage (must cover both aerobic and anaerobic organisms)
3. Failure to monitor for extension of infection into deep neck spaces
4. Inadequate follow-up to ensure resolution

Most patients with peritonsillar abscess can be managed successfully in the outpatient setting with appropriate drainage, antibiotics, and supportive care 2.