Treatment of Peritonsillar Abscess

Immediate Management Approach

The American College of Physicians recommends providing adequate hydration, as volume depletion is common from fever, poor oral intake, and tachypnea, in patients with peritonsillar abscess 1
The Infectious Diseases Society of America suggests that source control through drainage is essential for treatment success, and antibiotics alone without drainage should not be relied upon, in the management of peritonsillar abscess 2

The Clinical Infectious Diseases guidelines suggest that patients with severe systemic symptoms, inability to maintain hydration, or signs of sepsis should be admitted, while most patients can be managed as outpatients with the combination of drainage, antibiotics, steroids, and pain control 1

Empiric antibiotic therapy should be initiated once peritonsillar abscess is diagnosed, with antibiotics effective against group A streptococcus and oral anaerobes, as recommended by the Infectious Diseases Society of America 3
For patients with a history of more than one peritonsillar abscess, tonsillectomy should be considered as a definitive treatment, as suggested by the Infectious Diseases Society of America 4

Confirm diagnosis through clinical examination (and imaging if necessary), and initiate treatment promptly, including drainage, antibiotic therapy, and supportive care, as recommended by the Infectious Diseases Society of America 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends using ibuprofen, acetaminophen, or both for adequate pain control, which is essential for maintaining oral intake and hydration 5
For patients with a history of more than one peritonsillar abscess, tonsillectomy should be considered as definitive treatment, as it represents a modifying factor that favors tonsillectomy even if Paradise criteria for recurrent tonsillitis are not met 6, 5

The American Academy of Otolaryngology recommends avoiding potentially nephrotoxic antibiotics like aminoglycosides in the treatment of peritonsillar abscess 7

Unilateral tonsillectomy may be associated with a 14% risk of developing contralateral streptococcal tonsillitis and a 7% risk of developing contralateral peritonsillar complications, although no specific citation is provided in the text, this fact is mentioned in the context of 7

The World Journal of Emergency Surgery guidelines recommend a duration of antibiotics for 3-5 days after adequate source control for peritonsillar abscess 8