Peritonsillar Abscess in Emergency Medicine Medication

  • Author: Audrey J Tan, DO; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 30, 2012
 

Medication Summary

Antibiotics are the main component of therapy.

Begin antibiotic therapy prior to needle aspiration and report of culture results.

Though several studies have shown intravenous penicillin alone is clinically effective (provided the abscess is adequately drained), other studies have reported that greater than 50% of cultures grow beta-lactamase – producing anaerobes, leading to the tendency to use broader-spectrum antibiotics such as clindamycin or a second- or third-generation oral cephalosporin.

In those patients allergic to penicillin, clindamycin is a good choice.

Analgesics and throat washes are recommended.

As mentioned above, some physicians report using adjunctive steroids to decrease edema and pain.

Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

View full drug information

Clindamycin (Cleocin)

 

Semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of parent compound lincomycin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Widely distributes in the body without penetration of CNS. Protein bound and excreted by the liver and kidneys.

Oral or parenteral antibiotic for anaerobic or susceptible streptococcal, pneumococcal, or staphylococcal species. Considered to have good absorption into bloodstream in both oral and parental forms.

View full drug information

Penicillin G benzathine (Bicillin L-A)

 

DOC in combination with metronidazole. Effective in approximately 98% of patients. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

View full drug information

Metronidazole (Flagyl)

 

DOC in combination with penicillin. Effective in approximately 98% of treated patients.

Imidazole ring-based antibiotic active against various anaerobic bacteria and protozoa. Appears to be absorbed into the cells of microorganisms that contain nitroreductase. Unstable intermediate compounds are formed that bind DNA and inhibit synthesis, causing cell death.

View full drug information

Nafcillin (Unipen)

 

Initial therapy for suspected penicillin G-resistant streptococcal or staphylococcal infections.

Use parenteral therapy initially in severe infections. Change to PO therapy as condition warrants.

Because of thrombophlebitis, particularly in elderly persons, administer parenterally only for short term (1-2 d); change to PO route as clinically indicated.

View full drug information

Erythromycin (E.E.S, Ery-Tab, Erythrocin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal (including S aureus) and streptococcal infections.

Indicated if patient is allergic to penicillin.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Audrey J Tan, DO  Staff Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital Center

Audrey J Tan, DO is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ninfa Mehta, MD  Fellowship Director in Ultrasound Division, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Ninfa Mehta, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Glick, DMD  Dean, University of Buffalo School of Dental Medicine

Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mark W Fourre, MD  Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, A Antoine Kazzi, MD, and Mazen J El-Sayed, MD, to the development and writing of this article.

References

  1. Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. Mar 2003;128(3):332-43. [Medline].

  2. Steyer TE. Peritonsillar abscess: diagnosis and treatment. Am Fam Physician. Jan 1 2002;65(1):93-6. [Medline].

  3. Galioto NJ. Peritonsillar abscess. Am Fam Physician. Jan 15 2008;77(2):199-202. [Medline].

  4. Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. Jun 2008;41(3):459-83, vii. [Medline].

  5. Johnson RF, Stewart MG. The contemporary approach to diagnosis and management of peritonsillar abscess. Curr Opin Otolaryngol Head Neck Surg. Jun 2005;13(3):157-60. [Medline].

  6. Herzon FS. Harris P. Mosher Award thesis. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Laryngoscope. Aug 1995;105(8 Pt 3 Suppl 74):1-17. [Medline].

  7. Sakae FA, Imamura R, Sennes LU, Araujo Filho BC, Tsuji DH. [Microbiology of peritonsillar abscesses]. Rev Bras Otorrinolaringol (Engl Ed). Mar-Apr 2006;72(2):247-51. [Medline].

  8. Klug TE, Henriksen JJ, Fuursted K, Ovesen T. Significant pathogens in peritonsillar abscesses. Eur J Clin Microbiol Infect Dis. May 2011;30(5):619-27. [Medline].

  9. Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med. Jan 2005;12(1):85-8. [Medline].

  10. Johnson RF, Stewart MG, Wright CC. An evidence-based review of the treatment of peritonsillar abscess. Otolaryngol Head Neck Surg. Mar 2003;128(3):332-43. [Medline].

  11. Rahn R, Hutten-Czapski P. Quinsy (peritonsillar abscess). Can J Rural Med. Winter 2009;14(1):25-6. [Medline].

  12. Losanoff JE, Missavage AE. Neglected peritonsillar abscess resulting in necrotizing soft tissue infection of the neck and chest wall. Int J Clin Pract. Dec 2005;59(12):1476-8. [Medline].

  13. Ahmed K, et al. Radiology in focus: The role of ultrasound in the management of peritonsillar abscess. J Laryngol Otol. 1994;108:610-612.

  14. Aldakhail AA, Khan MI. A retrospective study of peritonsillar abscess in Riyadh Medical Complex [corrected]. Saudi Med J. Aug 2006;27(8):1217-21. [Medline].

  15. Araujo Filho BC, Sakae FA, Sennes LU, Imamura R, de Menezes MR. Intraoral and transcutaneous cervical ultrasound in the differential diagnosis of peritonsillar cellulitis and abscesses. Rev Bras Otorrinolaringol (Engl Ed). May-Jun 2006;72(3):377-81. [Medline].

  16. Blokmanis A. Ultrasound in the diagnosis and management of peritonsillar abscesses. J Otolaryngol. Aug 1994;23(4):260-2. [Medline].

  17. Fauci AS, et al. Harrison's Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998:183.

  18. Garcia Callejo FJ, Nunez Gomez F, Sala Franco J, Marco Algarra J. [Management of peritonsillar infections]. An Pediatr (Barc). Jul 2006;65(1):37-43. [Medline].

  19. Hanna BC, McMullan R, Hall SJ. Corticosteroids and peritonsillar abscess formation in infectious mononucleosis. J Laryngol Otol. Jun 2004;118(6):459-61. [Medline].

  20. Herzon FS, Martin AD. Medical and surgical treatment of peritonsillar, retropharyngeal, and parapharyngeal abscesses. Curr Infect Dis Rep. May 2006;8(3):196-202. [Medline].

  21. Kieff DA, Bhattacharyya N, Siegel NS, Salman SD. Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Head Neck Surg. Jan 1999;120(1):57-61. [Medline].

  22. Lamkin RH, Portt J. An outpatient medical treatment protocol for peritonsillar abscess. Ear Nose Throat J. Oct 2006;85(10):658, 660. [Medline].

  23. Lyon M, Blaivas M. Intraoral ultrasound in the diagnosis and treatment of suspected peritonsillar abscess in the emergency department. Acad Emerg Med. Jan 2005;12(1):85-8. [Medline].

  24. Martin Campagne E, del Castillo Martin F, Martinez Lopez MM, Borque de Andres C, de Jose Gomez MI, Garcia de Miguel MJ. [Peritonsillar and retropharyngeal abscesses: study of 13 years]. An Pediatr (Barc). Jul 2006;65(1):32-6. [Medline].

  25. Ozbek C, Aygenc E, Tuna EU, Selcuk A, Ozdem C. Use of steroids in the treatment of peritonsillar abscess. J Laryngol Otol. Jun 2004;118(6):439-42. [Medline].

  26. Passy V. Pathogenesis of peritonsillar abscess. Laryngoscope. Feb 1994;104(2):185-90. [Medline].

  27. Roberts J. Emergency department considerations in the diagnosis and treatment of peritonsillar abscess. Emerg Med News. 1996;2:4-7.

  28. Sakaguchi M, Sato S, Asawa S, Taguchi K. Computed tomographic findings in peritonsillar abscess and cellulitis. J Laryngol Otol. May 1995;109(5):449-51. [Medline].

  29. Strong EB, Woodward PJ, Johnson LP. Intraoral ultrasound evaluation of peritonsillar abscess. Laryngoscope. Aug 1995;105(8 Pt 1):779-82. [Medline].

  30. Tintinalli J, et al, eds. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill; 1996:1077-1078.

 
Previous
Next
 
Right peritonsillar abscess. The soft palate, which is erythematous and edematous, is displaced anteriorly. The patient has a "hot potato–sounding" voice.
Pus is aspirated through a wide-bore needle from the right peritonsillar abscess. An additional incision will be made to drain any other pus pockets.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.