eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pediatric Otolaryngology

Tonsillitis and Peritonsillar Abscess: Treatment & Medication

Author: Udayan K Shah, MD, Associate Professor of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University; Director, Fellow and Resident Education in Pediatric Otolaryngology, Attending Surgeon, Division of Otolaryngology, Nemours-AI duPont Hospital for Children
Contributor Information and Disclosures

Updated: Apr 22, 2009

Treatment

Medical Care

Treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate hydration and caloric intake and controlling pain and fever. Inability to maintain adequate oral caloric and fluid intake may require IV hydration, antibiotics, and pain control. IV corticosteroids may be administered to reduce pharyngeal edema.

  • Corticosteroids may shorten the duration of fever and pharyngitis in cases of infectious mononucleosis (MN). In severe cases of MN, corticosteroids or gammaglobulin may be helpful. Symptoms of MN may last for several months. Corticosteroids are also indicated for patients with airway obstruction, hemolytic anemia, and cardiac and neurologic disease. Inform patients of complications from steroid use.
  • Antibiotics are reserved for secondary bacterial pharyngitis. Because of the risk of a generalized papular rash, avoid ampicillin and related compounds when MN is suspected. Similar reactions from oral penicillin-based antibiotics (eg, cephalexin) have been reported. Therefore, initiate therapy with another antistreptococcal antibiotic such as erythromycin.
  • Administer antibiotics if conditions support bacterial etiology, such as the presence of tonsillar exudates, presence of a fever, leukocytosis, contacts who are ill, or contact with a person who has a documented GABHS infection. In many cases, bacterial and viral pharyngitis are clinically indistinguishable. Waiting 1-2 days for throat culture results has not been shown to diminish the usefulness of antibiotic therapy in preventing rheumatic fever.
  • GABHS infection obligates antibiotic coverage. Bisno et al stated, in a practice guideline for the diagnosis and management of group A beta-hemolytic Streptococcus pyogenes (GABHS), the desired outcomes of therapy for GABHS pharyngitis are (1) prevention of acute rheumatic fever, (2) prevention of suppurative complications, (3) abatement of clinical symptoms and signs, (4) reduction in transmission of GABHS to close contacts, and (5) minimization of potential adverse effects of inappropriate antimicrobial therapy.11
  • Administering oral penicillin for 10 days is the best treatment of acute GABHS pharyngitis. Intramuscular penicillin (ie, benzathine penicillin G) is required for persons who may not be compliant with a 10-day course of oral therapy. Penicillin is optimal for most patients (barring allergic reactions) because of its proven safety, efficacy, narrow spectrum, and low cost. Other antibiotics proven effective for GABHS pharyngitis are the penicillin congeners, many cephalosporins, macrolides, and clindamycin. Clindamycin may be of particular value because its tissue penetration is considered equivalent for both oral and IV administration. Clindamycin is effective even for organisms that are not rapidly dividing (Eagle effect), which explains its great efficacy for GABHS infection. Vancomycin and rifampin have also been useful. Reduced-frequency dosing is recommended to improve compliance with medication regimens. A consensus on the efficacy of such dosing has not yet been formulated.
  • Airway obstruction may require management by placing a nasal airway device, using intravenous corticosteroids, and administering humidified oxygen. Observe the patient in a monitored setting until the airway obstruction is clearly resolving.
  • Most acute pharyngitis is self-limited with clinical improvement observed in 3-4 days. Recent clinical practice guidelines state that avoiding antibiotic therapy for this time period is safe and that a delay of up to 9 days from symptom onset to antimicrobial treatment should still prevent the major complication of GABHS (ie, acute rheumatic fever).
  • Recurrent tonsillitis may be managed with the same antibiotics as acute GABHS pharyngitis. If the infection recurs shortly after a course of an oral penicillin agent, then consider IM benzathine penicillin G. Clindamycin and amoxicillin/clavulanate have been shown to be effective in eradicating GABHS from the pharynx in persons experiencing repeated bouts of tonsillitis. A 3- to 6-week course of an antibiotic against beta-lactamase–producing organisms (eg, amoxicillin/clavulanate) may allow tonsillectomy to be avoided.
  • Carrier state should be treated when the family has a history of rheumatic fever, a history of glomerulonephritis in the carrier, a "ping pong" spread of infection between household contacts of the carrier, familial anxiety regarding the implications of GABHS carriage, infectious outbreak within a closed community such as a school, an outbreak of acute rheumatic fever, or when tonsillectomy may be under consideration to treat the chronic carriage of GABHS.
  • Peritonsillar cellulitis may respond to oral antibiotics.
  • Antibiotics, either orally or intravenously, are required to treat PTA medically, although most peritonsillar abscesses (PTAs) are refractory to antibiotic therapy alone. Penicillin, its congeners (eg, amoxicillin/clavulanic acid, cephalosporins), and clindamycin are appropriate antibiotics.
  • Aetius of Amida, a sixth century Byzantine physician, managed spontaneously draining abscesses with gargles of honey, milk and herbs, or rose extract. In rare cases of spontaneous peritonsillar abscess (PTA) rupture, mouthwashes are still recommended for hygienic reasons. A 10-day course of an oral antibiotic is prescribed.

Surgical Care

  • Recurrent tonsillitis
    • Tonsillectomy is indicated for individuals who have experienced more than 6 episodes of streptococcal pharyngitis (confirmed by positive culture) in 1 year, 3 or more infections of tonsils and/or adenoids per year despite adequate medical therapy, or chronic or recurrent tonsillitis associated with the streptococcal carrier state that has not responded to beta-lactamase–resistant antibiotics.
    • Time missed from school or work and severity of illness (eg, whether hospitalization was required) are important considerations in recommending tonsillectomy.
    • Because adenoid tissue has similar bacteriology to the pharyngeal tonsils and minimal additional morbidity occurs with adenoidectomy if tonsillectomy is already being performed, most surgeons perform adenoidectomy if adenoids are present and inflamed at the time of tonsillectomy. However, this point remains controversial.
    • Recurrent tonsillitis after tonsillectomy is extremely rare. Tonsillectomy reduces the bacterial load of GABHS and may also allow an increase in alpha-Streptococcus, which can be protective against GABHS infection. Recurrent tonsillitis is usually due to regrowth of tonsillar tissue, which is treated by excision.
  • Chronic tonsillitis
    • Tonsillectomy with or without adenoidectomy is the treatment of chronic tonsillitis. The details of the technique are reviewed in the article on Tonsillectomy.
    • In cases of chronic tonsillitis, specific technical considerations for tonsillectomy include awareness of a higher intraoperative and perioperative bleeding risk and awareness that dissection may be more difficult because of fibrosis and scarring of the tonsillar capsule. Such considerations may affect instrument selection and discharge decisions.
  • Lingual tonsillitis
    • Surgery is rarely required for acute lingual tonsillitis.
    • Surgery is indicated for frequent and disabling episodes of this uncommon malady.
  • Tonsillitis in cases of MN: Tonsillar hypertrophy that persists after resolution of MN and causes obstructive airway symptoms may require tonsillectomy.
  • Peritonsillar abscess
    • Treatment of peritonsillar abscesses (PTAs) includes aspiration and incision and drainage (I&D).
    • Aetius recommended incision if an abscess did not spontaneously drain.
    • When peritonsillar abscess (PTA) is suspected, aspiration with a needle may be attempted to confirm the diagnosis and to remove some of the purulence.
      • The area of the peritonsillar abscess (PTA) is first anesthetized by infiltration with local anesthetic or by spray or sponge application of topical anesthesia (eg, Americaine, benzocaine). Sedation may be helpful; administer sedation only in a facility that is appropriately staffed and equipped.
      • An 18-gauge needle on a 1 mL tuberculin syringe is placed into the pointing area, taking care not to penetrate the pharyngeal mucosa more than 1 inch in order to prevent injury to the vessels and nerves of the parapharyngeal space.
      • If attempt at aspiration from 3 different peritonsillar sites does not locate the abscess, treat the patient with oral or IV antibiotics. If symptoms persist after 24-48 hours of therapy, CT scanning with contrast may be performed.
    • Once purulence is detected, complete aspiration may be attempted. In the author's experience, limited aspiration is best, provided that sufficient material is available for Gram stain and cultures with antibiotic sensitivities. Not all patients need microbiologic evaluation. For those who are immunosuppressed or who have developed a peritonsillar abscess (PTA) after several days of appropriate antibiotic therapy, send aspirated material for Gram stain, culture, and sensitivity tests.
    • After needle aspiration, incision and drainage may be performed using a knife.
      • The handle of a knife with an attached No 15 blade is taped 1 inch from the tip to prevent deep penetration through the mucosa. A gentle curvilinear incision, not more than half an inch deep, is fashioned along the perimeter of the tonsillar capsule and through the point from which pus was evacuated. A widely tipped blunt clamp (eg, Kelly clamp) is used to widely open the loculated pockets of purulence. A sponge-covered finger to break loculations is ideal. Rinsing with half-strength hydrogen peroxide solution aids hemostasis.
      • When the patient is dehydrated and uncomfortable, this well-intentioned procedure is not greeted with enthusiasm from the patient. Sedation, hydration, analgesia, and anesthesia (at the least, topical or local) are important.
      • Using the nondominant hand, the physician grasps the tongue with a sponge and observes the posterior oropharynx. In patients with severe trismus, a tongue blade may be used to depress the midportion of the tongue. Magnifying and illuminating loupes, such as the LumiView, are the best sources of light. A headlight or mirror is also effective. Arranging the instruments in order of use on a tray adjacent to the physician's dominant hand facilitates rapid accomplishment of this procedure. In experienced hands, this procedure should take fewer than 3 minutes from aspiration to rinsing with peroxide.
      • Some adults and most children require deeper levels of sedation or general anesthesia for safe and adequate aspiration or drainage. An institution with a carefully designed policy for incision and drainage of peritonsillar abscess (PTA) with conscious sedation, including appropriate indications, staff, and criteria, may offer sedation to children.
      • After the procedure, the patient is observed in accordance with sedation and anesthetic protocols. Hospitalization for adults and for older children is rarely required. The patient is discharged with a prescription for an oral antibiotic (10-d course of therapy), a prescription for an oral narcotic for pain control (taking care to avoid antiplatelet agents), and instructions to maintain hydration and control fever. Antibiotic therapy may be altered after cultures return. A follow-up office visit or telephone call is made in 2-4 weeks after the procedure to confirm symptomatic resolution.
    • Tonsillectomy is indicated for peritonsillar abscess (PTA) associated with chronic or recurrent tonsillitis or for exposure of the abscess in unusual cases. Newer techniques and technologies offer improved recovery and reduced complications from surgery.12 Acute tonsillectomy is generally regarded as a safe and effective treatment of peritonsillar abscess (PTA). Some physicians advocate immediate tonsillectomy for younger patients with peritonsillar abscess (PTA). Removing hot tonsils (ie, those that are acutely infected) carries the expectation of higher intraoperative blood loss and a higher risk of immediate and delayed posttonsillectomy hemorrhage.
    • The term quinsy tonsillectomy refers to tonsillectomy performed to treat peritonsillar abscess (PTA). Bilateral tonsillectomy is usually performed in these cases, and the abscessed tonsil is usually easier to remove during surgery than the inflamed contralateral tonsil. The abscessed tonsil is easier to remove because the abscess partially dissects the tonsil from the pharyngeal musculature.
    • During surgery, if the abscess cannot be located in the usual superior lateral region of the tonsillar fossa, then careful exploration with needle aspiration may locate the collection, allowing for wide exposure and drainage. Tonsillectomy may be required for exposure in such cases. A CT scan with contrast may be indicated.
    • Fleshy or pale, granular tonsillar tissue may indicate a neoplasm. Immuno-histopathologic examination is indicated in such cases.

Consultations

Consultations with infectious-disease, hematologic, and pediatric subspecialists are valuable in selected cases.

Diet

  • Hydration is important, and the oral route is usually adequate.
  • Intravenous fluids may be required for severe dehydration.
  • Hyperalimentation is rarely necessary.

Activity

  • Adequate rest for adults and children with tonsillitis accelerates recovery.
  • In order to reduce risk of splenic rupture in persons diagnosed with systemic mononucleosis (MN), patients must be cautioned against activities that may cause abdominal injury.

Medication

Medications used to manage tonsillitis include antibiotics, anti-inflammatory agents (eg, corticosteroids), antipyretics and analgesics (eg, acetaminophen, ibuprofen), and immunologic agents (eg, gammaglobulin).

Corticosteroids

The following agents reduce inflammation, which may impair swallowing and breathing.


Dexamethasone (Decadron, AK-Dex)

Short-acting, rapid-onset glucocorticoid.

Adult

Not established

Pediatric

0.5-1 mg/kg IV q8h; not to exceed 10 mg q8h; discontinue by tapering if prolonged use

Enhanced effect of steroids in hypothyroidism and cirrhosis; use aspirin with caution in conjunction with corticosteroids and hypoprothrombinemia; phenytoin, phenobarbital, ephedrine, and rifampin may enhance metabolic clearance of corticosteroids; check PT when using corticosteroids and coumarin

Documented hypersensitivity; sulfite sensitivity, though rare, is more common in individuals with asthma; systemic fungal infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Growth suppression in infants breastfed by mother using dexamethasone; injection contains sodium bisulfite; salt and water retention, therefore, hypertension risk; electrolyte imbalance; live-virus vaccination risk; tuberculosis risk with active and latent tuberculosis; risk of relative adrenocortical insufficiency after rapid withdrawal; masking signs of infection; ocular complications; behavioral changes; wound-healing problems; aggravation of peptic ulcer disease; male infertility

Antibiotics

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.


Penicillin (Benzathine, Permapen)

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.

Adult

1.2 million U IM, preferably into upper outer quadrant of buttock

Pediatric

<60 lb: 300,000-600,000 U IM; not to exceed 900,000 U IM; consulting hospital formulary at physician's institution recommended
>60 lb: Administer as in adults

Probenecid can increase penicillin effectiveness by decreasing clearance; coadministration with tetracyclines can decrease effectiveness

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Not for injection into or near artery or nerve; caution with cephalosporin and procaine sensitivities; may cause pseudomembranous colitis; with neurovascular injection, may observe severe neurovascular damage with myelitis resulting in paralysis or gangrene resulting in amputation; with intravascular injection, pallor, mottling, cyanosis, and edema requiring fasciotomies may occur; caution when using in mothers who are breastfeeding; hemolytic anemia, leukopenia, and thrombocytopenia; overdose may cause neuromuscular hyperirritability or convulsive seizures


Clarithromycin (Biaxin)

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. Semisynthetic macrolide with bid dosing.

Adult

250 mg PO q12h for 10 d

Pediatric

7.5 mg/kg PO q12h; not to exceed 250 mg/dose

Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, HMG CoA-reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents

Documented hypersensitivity; coadministration of pimozide

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; administer half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies


Clindamycin (Cleocin)

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.

Adult

150-450 mg PO q8h
1.2-2.7 g IV/IM q8h

Pediatric

Neonates: Consult hospital pharmacy
Infants and children: 15-25 mg/kg/d PO q8h; 25-40 mg/kg/d IV/IM q8h

Increases duration of neuromuscular blockade, induced by tubocurarine and pancuronium; erythromycin may antagonize effects of clindamycin; antidiarrheals may delay absorption

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis by allowing overgrowth of Clostridium difficile


Vancomycin (Vancocin, Lyphocin)

Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins, or who have infections with resistant staphylococci. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance (CrCl) to adjust dose in patients diagnosed with renal impairment. Used in conjunction with gentamicin for prophylaxis in penicillin allergic patients undergoing gastrointestinal or genitourinary procedures.

Adult

500 mg IV q6h or 1000 mg IV q12h

Pediatric

10 mg/kg IV q6h in neonates and infants; in first wk of life, 15 mg/kg IV first dose, followed by 10 mg/kg IV q12h, then q8h up to age 1 mo

Potent antibiotic directed against gram-positive organisms and active against Enterococcus species; useful in the treatment of septicemia and skin structure infections; indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins, or who have infections with resistant staphylococci; for abdominal penetrating injuries, it is combined with an agent active against enteric flora and/or anaerobes; to avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing; use CrCl to adjust dose in patients diagnosed with renal impairment; used in conjunction with gentamicin for prophylaxis in penicillin allergic patients undergoing gastrointestinal or genitourinary procedures

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Rapid infusion associated with hypotension and, rarely, cardiac arrest; ototoxicity, especially with other ototoxins (eg, aminoglycoside); caution with renal insufficiency; reversible neutropenia may occur; avoid extravasation; caution when administering other neurotoxic drugs or nephrotoxins (eg, amphotericin B, aminoglycosides, bacitracin)


Rifampin (Rifadin, Rimactane)

Inhibitor of bacterial DNA-dependent RNA polymerase activity.

Adult

Not used for this indication

Pediatric

<1 month: 5 mg/kg PO q12h for 2 d
>1 month: 10 mg/kg PO q12h for 2 d; not to exceed 600 mg/dose

Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin
Blood pressure may increase with coadministration of enalapril; coadministration with isoniazid may result in higher rate of hepatotoxicity than with either agent alone (discontinue 1 or both agents if alterations in LFTs occur)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Obtain CBC counts and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occurs; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur


Amoxicillin (Trimox, Amoxil, Biomox)

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

Adult

500-875 mg PO q12h or 250-500 PO q8h

Pediatric

<12 weeks: 30 mg/kg PO q12h for 10 d; recommended for prevention of poststreptococcal rheumatic fever
>3 months: 25 mg/kg/d PO q12h in 2 divided doses, 20 mg/kg/d q8h in 3 divided doses, or 45 mg/kg/d q12h in 2 divided doses

Probenecid increases levels; reduces the efficacy of oral contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Documented hypersensitivity; GI adverse effects; reversible anemia; thrombocytopenia; eosinophilia; leukopenia; behavioral changes; chewable tabs contain phenylalanine and, therefore, are a risk for those with phenylketonuria


Amoxicillin-clavulanate (Augmentin)

Oral antibiotic with specific activity against penicillin-resistant organisms, due to beta-lactamase inhibitor, clavulanate potassium.

Adult

500 mg tab PO q12h or one 250 mg tab PO q8h

Pediatric

<12 weeks: 30 mg/kg/d PO q12h in 2 divided doses, based on reduced renal elimination of the amoxicillin component
>3 months: 45 mg/kg/d PO q12h or 40 mg/kg/d q8h
>40 kg: Administer as in adults

Rash with ampicillin-related antibiotics in infectious mononucleosis; when used with probenecid, reduced renal tubular secretion, therefore, increased and prolonged blood levels with probenecid; PKU caution as with amoxicillin

Documented hypersensitivity to any penicillin; history of Augmentin-associated cholestatic jaundice and/or hepatic dysfunction

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Diarrhea, loose stools, nausea, skin rashes, vomiting, and anemia and other heme effects reversible upon discontinuation of drug; reported behavioral changes


Metronidazole (Flagyl)

Effective in patients with tonsillitis and MN, shortening fever duration and reducing tonsillar size, and in management of acute episodes of nonstreptococcal tonsillitis.

Adult

Loading dose: 15 mg/kg or 1 g for 70-kg adult IV over 1 h
Maintenance dose: 6 h following loading dose, infuse 7.5 mg/kg or 500 mg for 70-kg adult over 1 h q6-8h; not to exceed 4 g/d

Pediatric

Administer as in adults

May increase toxicity of anticoagulants, lithium, and phenytoin; cimetidine may increase toxicity of metronidazole; disulfiramlike reaction may occur with orally ingested ethanol

Pregnancy
Precautions

Adjust dose in hepatic disease; monitor for seizures and development of peripheral neuropathy

Immune globulins

These agents are used to improve clinical aspects of the disease.


Immune globulin intravenous (Gamimune N, Gammagard, Sandoglobulin)

Pooled human Ig. Because of shortage of supply, reserved for use for severe infections. Use in accordance with institutional policies. Use in past was more common for various indications.

Adult

Consult hospital pharmacy and medical consultants if necessary

Pediatric

Consult hospital pharmacy and medical consultants if necessary

Increases toxicity of live virus vaccine (MMR); do not administer within 3 mo of vaccine

Documented hypersensitivity; IgA deficiency; anti-IgE/IgG antibodies

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Check serum IgA before IVIG (use an IgA-depleted product, eg, Gammagard S/D); infusions may increase serum viscosity and thromboembolic events; infusions may increase risk of migraine attacks, aseptic meningitis (10%), urticaria, pruritus, or petechiae (2-5 d postinfusion to 30 d); increases risk of renal tubular necrosis in elderly, and in those with diabetes, volume depletion, and preexisting kidney disease
Lab result changes associated with infusions include elevated antiviral or antibacterial antibody titers for 1 mo, 6-fold increase in ESR for 2-3 wk, and apparent hyponatremia

More on Tonsillitis and Peritonsillar Abscess

Overview: Tonsillitis and Peritonsillar Abscess
Differential Diagnoses & Workup: Tonsillitis and Peritonsillar Abscess
Treatment & Medication: Tonsillitis and Peritonsillar Abscess
Follow-up: Tonsillitis and Peritonsillar Abscess
Multimedia: Tonsillitis and Peritonsillar Abscess
References
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Further Reading

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Keywords

tonsillitis and peritonsillar abscess, tonsillitis, tonsils, peritonsillar abscess, quinsy, acute tonsillitis, recurrent tonsillitis, chronic tonsillitis, pharyngitis, pharyngotonsillitis, adenotonsillitis, PTA, inflammation of the pharyngeal tonsils, lingual tonsillitis, group A beta-hemolytic Streptococcus pyogenes, GABHS, GABHS pharyngitis, adenoidectomy, trismus, quinsy tonsillectomy, abscessed tonsil, bilateral tonsillectomy, sore throat, throat infection, rheumatic fever, scarlet fever

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Contributor Information and Disclosures

Author

Udayan K Shah, MD, Associate Professor of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University; Director, Fellow and Resident Education in Pediatric Otolaryngology, Attending Surgeon, Division of Otolaryngology, Nemours-AI duPont Hospital for Children
Udayan K Shah, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Pediatric Otolaryngology, International Society for Optical Engineering, Pennsylvania Medical Society, Phi Beta Kappa, and Society for Ear, Nose and Throat Advances in Children
Disclosure: Arthrocare, Inc Consulting fee Consulting; Gyrus-ACMI Consulting fee Consulting

Medical Editor

Ari J Goldsmith, MD, Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center
Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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