What is the recommended dosage of Augmentin (amoxicillin/clavulanate) and prednisone for a peritonsillar abscess?

Augmentin and Prednisone Dosing for Peritonsillar Abscess

For peritonsillar abscess, use Augmentin (amoxicillin-clavulanate) 875/125 mg orally twice daily for 7-10 days following drainage, and add a single high-dose intravenous steroid (such as dexamethasone 10 mg IV or methylprednisolone 125 mg IV) at presentation to significantly reduce pain, fever, trismus, and hospital stay.

Antibiotic Selection and Dosing

• Augmentin 875/125 mg orally twice daily is the appropriate dose for peritonsillar abscess 1
• The standard duration is 7-10 days following drainage 2
• Peritonsillar abscess is caused by mixed aerobic and anaerobic bacteria, with Streptococcus pyogenes and Staphylococcus aureus being the most common organisms 3
• Augmentin provides coverage for both penicillin-sensitive Streptococcus pyogenes and beta-lactamase producing Staphylococcus aureus, which are resistant to penicillin alone 3
• Alternative antibiotics include clindamycin, cephalosporins, or metronidazole if beta-lactam allergy exists 2

Corticosteroid Use

• A single high-dose intravenous steroid should be administered at presentation in addition to drainage and antibiotics 4
• Studies demonstrate statistically significant improvement (p < 0.01) in throat pain, fever, trismus, and hours hospitalized when steroids are added to antibiotic therapy 4
• The steroid should be given as a single dose prior to or concurrent with antibiotic initiation 4
• Common regimens include dexamethasone 10 mg IV or methylprednisolone 125 mg IV as a one-time dose 5, 4

Critical Management Principles

• Drainage is mandatory and must not be delayed - antibiotics alone are insufficient 2
• Needle aspiration at three points is the gold standard for both diagnosis and treatment, with a 70% positive aspiration rate 6
• Repeat aspiration may be necessary in approximately 10% of patients 6
• Incision and drainage or immediate tonsillectomy may be required in advanced cases where needle aspiration fails 2

Common Pitfalls to Avoid

• Do not substitute two 250/125 mg tablets for one 500/125 mg tablet - this results in excessive clavulanate dosing and increased gastrointestinal side effects 1
• Do not prescribe antibiotics without performing drainage - this will result in treatment failure regardless of antibiotic choice 2
• Do not use penicillin alone, as Staphylococcus aureus (present in many cases) is uniformly resistant to it 3
• Take Augmentin at the start of meals to enhance clavulanate absorption and minimize gastrointestinal intolerance 1