From the Guidelines
Outpatient treatment of peritonsillar abscess should involve a combination of drainage and antibiotics, with drainage being the primary treatment, as recommended by the American College of Emergency Physicians 1. The primary treatment is drainage of the abscess, which can be performed via needle aspiration or incision and drainage in an outpatient setting by an experienced clinician. Following drainage, empiric antibiotic therapy should be initiated with amoxicillin-clavulanate 875/125 mg orally twice daily for 10-14 days, as this provides broad-spectrum coverage of Gram-positive, Gram-negative, and anaerobic bacteria, which are commonly involved in peritonsillar abscesses 1. Some key points to consider in the treatment of peritonsillar abscess include:
- Alternative options for patients with penicillin allergy, such as clindamycin 300-450 mg orally four times daily
- Pain management with acetaminophen or ibuprofen, and reserving stronger analgesics like oxycodone/acetaminophen for severe pain
- Maintaining adequate hydration and following a soft diet to minimize discomfort during swallowing
- Close follow-up within 24-48 hours to assess treatment response
- Considering hospitalization for patients with severe symptoms, inability to maintain oral intake, significant comorbidities, or signs of airway compromise. It is essential to note that the treatment approach should target the polymicrobial nature of peritonsillar abscesses, which typically involve aerobic and anaerobic bacteria, particularly group A streptococci and oral anaerobes, while providing symptomatic relief during recovery.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Peritonsillar Abscess Outpatient Treatment
- Outpatient management of peritonsillar abscess is possible with a high degree of patient satisfaction, as shown in a study where 93% of patients were happy to have been treated as outpatients 2.
- Initial treatment with analgesia, co-amoxiclav, and dexamethasone intravenously can be effective in managing peritonsillar abscess on an outpatient basis 2.
- Antibiotic choice is crucial in the treatment of peritonsillar abscess, with amoxicillin-clavulanic acid suggested as the first drug of choice for patients presenting with unilateral peritonsillar swelling and trismus 3.
- A comparison of outpatient intramuscular clindamycin and inpatient intravenous ampicillin/sulbactam following needle aspiration showed no statistically significant difference in clinical outcomes, suggesting that clindamycin can be safely prescribed on an outpatient basis 4.
- The selection of antibiotics after incision and drainage of peritonsillar abscesses is still controversial, but a retrospective review found that intravenous penicillin remains an excellent choice for therapy in cases requiring parenteral antibiotics after drainage 5.
Key Findings
- Peritonsillar abscess can be managed successfully as outpatients with a high degree of patient satisfaction 2.
- Amoxicillin-clavulanic acid may be an effective first-line antibiotic treatment for peritonsillar abscess 3.
- Clindamycin can be a suitable alternative to ampicillin/sulbactam for outpatient treatment of peritonsillar abscess 4.
- Penicillin remains a viable option for parenteral antibiotic therapy after drainage of peritonsillar abscess 5.