Peritonsillar abscess medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Medical therapy is the first liine treatment modality for peritonsillar abscess. Parenteral therapy is the preferred first line route of administration until the temperature of the patient has settled and clinically improved and then switched to oral therapy to complete a 14-day course. The preferred emperic therapy is ampicillin-sulbactam with clindamycin as alternative agent. For resistant gram-positive cocci infections intravenous vancomycin or linezolid is added to the above emperic therapy.

Medical therapy

Medical therapy is the first liine treatment modality for peritonsillar abscess.

Parenteral therapy is the preferred first line route of administration until the temperature of the patient has settled and clinically improved and then switched to oral therapy to complete a 14-day course.

Antimicrobial Regimen

Below are the emperic antimicrobial regimen available in treating peritonsillar abscess.

• Preferred regimen in adults: Ampicillin-sulbactam 3 g IV 6h

• Preferred regimen in children: Ampicillin-sulbactam 50 mg/kg per dose [maximum single dose 3 g] IV 6h

• Alternative regimen in adults: Clindamycin 600mg IV 6-8h

• Alternative regimen in children: Clindamycin 13 mg/kg per dose [maximum single dose 900 mg] IV 8h

The above alternative therapy are employed in the following situations:

• Patients not improving on Ampicillin-sulbactam or Clindamycin
• Severe infection presenting with;
  • Toxic appearance,
  • Temperature >39°C,
  • Drooling, and/or respiratory distress)

Pathogen-directed antimicrobial therapy

• Resistant Gram-positive cocci

For resistant gram-positive cocci infections intravenous Vancomycin or linezolid is added to the above emperic therapy.