From the Guidelines
Dexamethasone (Decadron) is recommended for use in the treatment of peritonsillar abscess, particularly in the context of tonsillectomy, as it helps reduce inflammation, pain, and trismus associated with the condition. The use of dexamethasone in this setting is supported by the most recent clinical practice guideline update, which recommends administering a single intraoperative dose of intravenous dexamethasone to children undergoing tonsillectomy 1. Although the guideline primarily focuses on tonsillectomy in children, the principle of using dexamethasone to reduce inflammation and improve symptoms can be applied to the treatment of peritonsillar abscess.
Key Considerations
- Dexamethasone should be used alongside appropriate antibiotic therapy and drainage of the abscess through needle aspiration or incision and drainage.
- Patients should be monitored for improvement in symptoms, including pain, fever, and ability to swallow, with follow-up recommended within 24-48 hours after initial treatment.
- The dosage of dexamethasone may vary, but a typical regimen includes a single dose of 10 mg IV or IM at the time of diagnosis and treatment, or a short course of oral dexamethasone.
Evidence-Based Recommendation
The recommendation to use dexamethasone in the treatment of peritonsillar abscess is based on the most recent and highest quality study available, which is the 2019 clinical practice guideline update on tonsillectomy in children 1. This guideline provides evidence-based recommendations on the use of dexamethasone in the perioperative management of children undergoing tonsillectomy, which can be applied to the treatment of peritonsillar abscess. The earlier guideline from 2011 also supports the use of dexamethasone in this context, but the 2019 update provides more recent and relevant evidence 1.
From the Research
Treatment of Peritonsillar Abscess
- Peritonsillar abscess is a common infection that requires prompt treatment, with options including needle aspiration, incision and drainage, and antibiotic therapy 2, 3.
- The use of corticosteroids, such as dexamethasone, in the treatment of peritonsillar abscess has been studied, with some evidence suggesting that it may be beneficial in reducing pain and improving symptoms 4, 5, 6.
Use of Dexamethasone in Peritonsillar Abscess Treatment
- A randomized, double-blind, placebo-controlled trial found that a single dose of intravenous dexamethasone resulted in lower pain scores at 24 hours compared to placebo, although this effect was short-lived 5.
- Another study found that the use of a single high dose of steroid, in addition to intravenous antibiotic therapy, was more effective than antibiotic therapy alone in relieving symptoms such as fever, throat pain, and trismus 6.
- However, the evidence for the use of dexamethasone in peritonsillar abscess treatment is not yet conclusive, and further research is needed to fully understand its effects 5.
Clinical Outcomes and Treatment Protocols
- A medical protocol involving hydration, antibiotics, steroids, and good pain control has been shown to be effective in treating peritonsillar abscess in an outpatient setting, with only 4.1% of patients requiring subsequent needle aspiration or incision and drainage 4.
- The use of dexamethasone in combination with other treatments, such as needle aspiration and antibiotic therapy, may be a viable option for the management of peritonsillar abscess, although more research is needed to confirm its effectiveness 5, 6.