The treatment of peritonsillar abscess requires both the selection of appropriate antibiotics and the best procedure to remove the abscessed material. Individualized treatment modalities will result in more successful outcomes.
The choice of antibiotics is highly dependent on both the gram stain and culture of the fluid obtained from the needle aspiration. Penicillin used to be the antibiotic of choice for the treatment of peritonsillar abscess, but in recent years the emergence of beta-lactamase-producing organisms has required a change in antibiotic choice.15 Results of studies16,17 suggest that 500 mg of clindamycin administered twice daily or a second- or third-generation oral cephalosporin be used instead of penicillin.
Another study1 recommends using penicillin as the first-line agent, and, if there is no response within the first 24 hours, adding 500 mg of metronidazole administered twice daily to the regimen. All specimens should be examined by culture for antibiotic sensitivity to ensure appropriate antibiotic coverage.
Three main surgical procedures are available for the treatment of peritonsillar abscess: needle aspiration, incision and drainage, and immediate tonsillectomy. Three recent studies have compared needle aspiration with incision and drainage for the treatment of peritonsillar abscess.16–18
In one study,16 52 consecutive patients who had a positive needle aspiration of a peritonsillar abscess were randomized into two groups comparing needle aspiration alone with incision and drainage.8 There were no significant differences between the two groups in duration of symptoms or initial treatment failure. The results indicated that no further surgical management for peritonsillar abscess was required following the initial needle aspiration. Another study17 conducted in 1991 reported similar results.