From the Guidelines
Tonsillar abscess treatment should prioritize antibiotics and drainage of the abscess, with consideration for pain management and hydration, as recommended by the most recent guidelines 1.
Key Considerations
- The recommended antibiotic regimen includes penicillin (such as amoxicillin-clavulanate 875/125 mg twice daily) or clindamycin 300-450 mg four times daily for patients with penicillin allergy, for 10-14 days.
- Drainage is essential and can be performed via needle aspiration or incision and drainage by an otolaryngologist or emergency physician.
- Pain management with acetaminophen or ibuprofen is important, and patients should stay hydrated and may need to consume soft foods temporarily.
Tonsillar Abscess Formation
Tonsillar abscesses form when bacterial infections, often following tonsillitis, spread into the surrounding tissue. The most common bacteria involved are Streptococcus species and anaerobes.
Importance of Prompt Treatment
Without proper treatment, the infection can spread to deeper tissues of the neck or even the bloodstream, making prompt medical care crucial. If symptoms worsen despite treatment, including increased difficulty swallowing, breathing problems, or spreading infection, immediate medical attention is necessary.
Guideline Recommendations
The American Academy of Otolaryngology-Head and Neck Surgery recommends watchful waiting for recurrent throat infection if there have been fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years, or fewer than 3 episodes per year in the past 3 years 1. Additionally, the guidelines suggest that clinicians should assess the child with recurrent throat infection who does not meet criteria for modifying factors that may favor tonsillectomy, which may include multiple antibiotic allergies/intolerance, PFAPA, or history of peritonsillar abscess 1.
From the FDA Drug Label
Clindamycin Injection, USP is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the designated organisms in the conditions listed below: Intra-abdominal infections including peritonitis and intra-abdominal abscess caused by susceptible anaerobic organisms.
The FDA drug label does not answer the question about Tonseral abscess.
From the Research
Definition and Diagnosis of Peritonsillar Abscess
- Peritonsillar abscess (PTA) is a collection of pus located between the tonsillar capsule and the pharyngeal constrictor muscle 2.
- The presenting symptoms of PTA include fever, throat pain, and trismus 3.
- Ultrasonography and computed tomographic scanning are useful in confirming a diagnosis of PTA 3.
- Needle aspiration remains the gold standard for diagnosis and treatment of peritonsillar abscess 3, 4.
Treatment of Peritonsillar Abscess
- Appropriate antibiotic therapy, including penicillin, clindamycin, cephalosporins, or metronidazole, must be initiated after performing aspiration 3.
- In advanced cases, incision and drainage or immediate tonsillectomy may be required 3, 4.
- Immediate tonsillectomy in patients with peritonsillar abscess is a safe and effective treatment that should be considered as an alternative to conventional incision and drainage 5.
- Needle aspiration is an effective first-line procedure for patients with PTA, and tonsillectomy is not necessary in most cases 6.
Microbiology of Peritonsillar Abscess
- Group A streptococcus (GAS) is the only established pathogen in PTA, but it is only recovered from approximately 20% of PTA patients 2.
- Fusobacterium necrophorum (FN) is a significant and prevalent pathogen in PTA, and it is associated with increased risk of PTA development 2.
- The microbiology of PTA fluctuates with seasons, with GAS-positive PTA cases being more prevalent in the winter and spring, and FN-positive PTA patients exhibiting a more even distribution over the year 2.
Risk Factors and Complications
- Smoking is associated with increased risk of PTA for both genders and across all age groups 2.
- The incidence of PTA is highly related to age and gender, with teenagers and young adults being most commonly affected 2.
- Complications of PTA include parapharyngeal abscess, upper airway obstruction, Lemierre's syndrome, necrotizing fasciitis, mediastinitis, erosion of the internal carotid artery, brain abscess, and streptococcal toxic shock syndrome 2.