Treatment of Delayed Peritonsillar Abscess
The treatment of delayed peritonsillar abscess requires drainage of the abscess (either by needle aspiration or incision and drainage), antibiotic therapy effective against Group A streptococcus and oral anaerobes, and consideration of tonsillectomy for patients with recurrent episodes. 1, 2
Initial Management
- Drainage of the abscess is the cornerstone of treatment, with needle aspiration being the gold standard diagnostic and therapeutic procedure 3, 4
- Incision and drainage may be preferred over needle aspiration as it is associated with a lower recurrence rate, though needle aspiration is generally less painful 5
- Empiric antibiotic therapy should be initiated immediately after drainage and should be effective against both Group A streptococcus and oral anaerobes 2, 3
- Appropriate antibiotic options include:
- Penicillin
- Clindamycin
- Cephalosporins
- Metronidazole (often in combination with other antibiotics) 4
Adjunctive Therapy
- A single high-dose corticosteroid in addition to antibiotics can significantly reduce symptoms such as throat pain, trismus, fever, and may speed recovery 6, 7
- Supportive care is essential, including:
- Adequate hydration
- Pain control
- Monitoring for potential complications 3
Definitive Management for Recurrent Cases
- Tonsillectomy should be considered in patients with a history of more than one peritonsillar abscess, even if they don't meet the standard frequency criteria for recurrent throat infections 1, 2
- The American Academy of Otolaryngology-Head and Neck Surgery recommends considering tonsillectomy as a definitive treatment for patients with a history of peritonsillar abscess, particularly with multiple occurrences 1
Potential Complications to Monitor
- Airway obstruction requiring immediate intervention
- Extension of infection into deep neck tissues
- Aspiration
- Dehydration requiring hospital admission 3, 5
Treatment Algorithm
- Confirm diagnosis through clinical examination (fever, sore throat, dysphagia, trismus, and "hot potato" voice) and imaging if necessary 2, 3
- Perform drainage procedure (needle aspiration or incision and drainage) 4, 5
- Initiate empiric antibiotic therapy effective against Group A streptococcus and oral anaerobes 2, 3
- Consider single-dose corticosteroid to reduce symptoms 6
- Provide supportive care (hydration, pain control) 3
- For patients with recurrent peritonsillar abscess, consider tonsillectomy as definitive treatment 1, 2
Most patients with peritonsillar abscess can be managed in the outpatient setting, but close follow-up is essential to monitor for resolution or potential complications 3.