From the Research
Peritonsillar abscess treatment requires prompt medical attention and typically involves drainage of the abscess along with antibiotic therapy, with the most recent and highest quality study 1 supporting this approach. The primary treatment is incision and drainage of the abscess, which can be performed by an otolaryngologist or emergency physician using local anesthesia. This procedure provides immediate relief of symptoms and is essential for preventing complications.
Key Considerations
- Antibiotic therapy should be started immediately, with penicillin or amoxicillin-clavulanate being first-line options for 10-14 days, as they are effective against group A streptococcus and oral anaerobes 1.
- For penicillin-allergic patients, clindamycin is an appropriate alternative, as it is effective against both aerobic and anaerobic bacteria 2, 3.
- Pain management is also important, typically with acetaminophen or NSAIDs, and sometimes stronger analgesics if needed.
- Patients should maintain adequate hydration and may benefit from warm salt water gargles to reduce inflammation.
Treatment Approach
- The treatment approach should prioritize morbidity, mortality, and quality of life, with the goal of preventing complications and promoting complete resolution of the abscess.
- Hospitalization may be necessary for severe cases, particularly if the patient has difficulty swallowing, is dehydrated, or shows signs of airway compromise.
- Following treatment, patients should complete the full course of antibiotics even if symptoms improve, and follow up with their healthcare provider to ensure complete resolution and to discuss potential tonsillectomy if they have recurrent episodes.
Evidence-Based Recommendations
- The most recent and highest quality study 1 provides evidence-based recommendations for the treatment of peritonsillar abscess, including drainage of the abscess and antibiotic therapy with penicillin or amoxicillin-clavulanate.
- Other studies 4, 2, 3 support the importance of considering anaerobic bacteria in the treatment of peritonsillar abscess, and recommend the use of antibiotics effective against both aerobic and anaerobic bacteria.