What is the immediate treatment for a peritonsillar abscess?

Immediate Treatment of Peritonsillar Abscess

The immediate treatment for peritonsillar abscess requires prompt drainage of the abscess through needle aspiration, incision and drainage, or immediate tonsillectomy, along with empiric antibiotic therapy effective against group A streptococcus and oral anaerobes. 1, 2, 3

Diagnosis

• Diagnosis is typically based on clinical presentation including fever, sore throat, dysphagia, trismus (limited mouth opening), and a characteristic "hot potato" voice 2
• Imaging such as ultrasonography or CT scan may be useful in confirming the diagnosis in unclear cases 3

Immediate Management Algorithm

1. Drainage Procedure

• Needle aspiration is considered the gold standard for both diagnosis and initial treatment of peritonsillar abscess 3
• Alternatives include formal incision and drainage for larger abscesses 3
• Immediate tonsillectomy is a safe and effective option, particularly for patients with recurrent peritonsillar abscesses 4, 1

2. Antibiotic Therapy

• Initiate empiric antibiotic therapy immediately after diagnosis and drainage 1
• Select antibiotics effective against group A streptococcus and oral anaerobes, as peritonsillar abscesses are typically polymicrobial infections 2
• Recommended options include:
  • Amoxicillin-clavulanic acid (preferred in many cases) 5
  • Penicillin (though may be less effective than broader coverage) 5
  • Clindamycin (especially for penicillin-allergic patients) 3
  • Cephalosporins or metronidazole may be considered as alternatives 3

3. Supportive Care

• Ensure adequate hydration, as dysphagia may lead to decreased oral intake 2
• Provide appropriate pain control 6
• Consider corticosteroids to reduce inflammation and speed recovery 2

Special Considerations

• Most patients can be managed in the outpatient setting after drainage and initiation of antibiotics 2
• Hospitalization may be necessary for patients with:
  • Inability to maintain oral hydration 2
  • Severe symptoms or systemic illness 2
  • Risk of airway compromise 2
  • Need for IV antibiotics or pain control 2

Common Pitfalls

• Delaying drainage can lead to extension of infection into deep neck tissues, airway obstruction, or aspiration 2
• Using antibiotics alone without drainage is generally insufficient for definitive treatment of a formed abscess 3
• Inadequate antibiotic coverage (e.g., using penicillin V alone) may result in treatment failure 5
• Failure to consider tonsillectomy in patients with recurrent peritonsillar abscess 1, 4

Follow-up

• Close follow-up within 24-48 hours is essential to ensure clinical improvement 5
• Consider tonsillectomy for patients with history of recurrent peritonsillar abscesses 1