What is the treatment for a peritonsillar abscess?

Treatment of Peritonsillar Abscess

The definitive treatment for peritonsillar abscess requires drainage of the abscess (through needle aspiration or incision and drainage) combined with appropriate antibiotic therapy targeting group A streptococcus and anaerobes. 1, 2, 3

Diagnosis and Initial Assessment

• Peritonsillar abscess presents with severe throat pain, fever, dysphagia, trismus (difficulty opening mouth), and a "hot potato" voice 3
• Drooling and neck tenderness may occur in severe cases, indicating potential spread of infection 2
• Diagnosis is primarily clinical, though ultrasonography or CT scanning can confirm the diagnosis in uncertain cases 4

Treatment Algorithm

First-line Management:

1. Drainage procedure:

   • Needle aspiration is often the first-line drainage procedure and may be less painful than incision and drainage 5
   • Incision and drainage is associated with lower recurrence rates compared to needle aspiration 5
   • Either procedure effectively relieves symptoms by evacuating the purulent collection 3

2. Antibiotic therapy:

   • Empiric broad-spectrum antibiotics should be initiated immediately 1
   • Antibiotics should target group A streptococcus and oral anaerobes 2
   • Appropriate options include:
     • Penicillin
     • Clindamycin
     • Cephalosporins
     • Metronidazole 4

3. Supportive care:

   • Hydration
   • Pain control
   • Monitoring for complications 2, 3

Alternative Approaches:

• Outpatient medical management: In select cases, particularly when surgical expertise is not immediately available, a regimen of hydration, antibiotics, steroids, and pain control may be attempted, though this approach has a success rate of approximately 96% 6

• Immediate tonsillectomy: May be considered in cases of recurrent peritonsillar abscess or when drainage procedures fail 1, 7

Special Considerations

• Recurrent peritonsillar abscess: Patients with a history of more than one peritonsillar abscess should be considered for tonsillectomy as definitive treatment 1, 2

• Monitoring for complications: Vigilance is required for potential complications such as:

  • Airway obstruction
  • Aspiration
  • Extension of infection into deep neck tissues 2, 3

Follow-up

• Most patients can be managed in the outpatient setting after successful drainage and initiation of antibiotics 3
• Close follow-up is recommended to ensure resolution of symptoms and to monitor for recurrence 3
• Consider tonsillectomy for patients with recurrent episodes 1