Pediatric Peritonsillar Abscess Medication

  • Author: Itzhak Brook, MD, MSc; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 8, 2012
 

Medication Summary

Drugs used in the treatment of peritonsillar abscess (PTA) primarily include antibiotics and analgesics. Some otorhinolaryngologists also recommend use of corticosteroids for their anti-inflammatory effect. Whether these medications are given orally or intravenously depends on whether the patient is able to tolerate orally and whether the patient is being treated as an inpatient or outpatient. For analgesia, use of a combined opioid plus acetaminophen preparation is preferred.

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Antibiotics

Class Summary

The isolation of aerobic and anaerobic beta-lactamase–producing bacteria from most abscesses mandates the use of antimicrobial agents effective against these organisms. Beta-lactamase–producing bacteria include Prevotella, Fusobacterium, Haemophilus, and Staphylococcus species.

For outpatient management, a beta-lactam antibiotic is preferred. Amoxicillin plus clavulanate (Augmentin) is the drug of choice (DOC). For inpatient management, intravenous ampicillin plus sulbactam is preferred. Alternatively, a combination of intravenous ceftriaxone and clindamycin or a carbapenem (ie, imipenem, meropenem) is used for severe or complicated cases. Coverage for methicillin-resistant Staphylococcus aureus (MRSA) includes clindamycin, vancomycin, or linezolid.[22]

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Amoxicillin plus clavulanate (Augmentin)

 

Interferes with synthesis of cell wall peptidoglycan during active replication, resulting in bactericidal activity against susceptible microorganisms. Clavulanic acid is a potent beta-lactamase inhibitor, further broadening the spectrum of activity to include beta-lactamase–producing S aureus and anaerobes (eg, Prevotella species).

For children >3 months, base dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in 250-mg tab (250/125) vs 250 mg chewable-tab (250/62.5), do not use 250-mg tab until child weighs >40 kg.

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Imipenem and cilastatin (Primaxin)

 

For treatment of multiple organism infections in which other agents do not have wide spectrum coverage or are contraindicated due to potential for toxicity. Provides anaerobic coverage.

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Ampicillin plus sulbactam (Unasyn)

 

Interferes with synthesis of cell wall peptidoglycan during active replication, resulting in bactericidal activity against susceptible microorganisms. Clavulanic acid is a potent beta-lactamase inhibitor, further broadening the spectrum of activity to include beta-lactamase–producing S aureus and anaerobes (eg, Prevotella species).

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Clindamycin (Cleocin)

 

Alternative agent in patients allergic to penicillin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

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Ceftriaxone (Rocephin)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin binding proteins. Exerts antimicrobial effect by interfering with synthesis of peptidoglycan, a major structural component of bacterial cell wall. Bacteria eventually lyse due to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.

Highly stable in presence of beta-lactamases, both penicillinase and cephalosporinase, of gram-negative and gram-positive bacteria. Approximately 33-67% of dose excreted unchanged in urine, and remainder secreted in bile and ultimately in feces as microbiologically inactive compounds. Reversibly binds to human plasma proteins, and binding have been reported to decrease from 95% bound at plasma concentrations < 25 mcg/mL to 85% bound at 300 mcg/mL.

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Vancomycin (Vancocin)

 

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 are unable to receive or who have not responded to penicillins and cephalosporins or for infections with resistant staphylococci. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.

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Linezolid (Zyvox)

 

Prevents formation of functional 70S initiation complex, which is essential for bacterial translation process. Bacteriostatic against staphylococci.

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Analgesic agents

Class Summary

Pain control is essential to quality patient care.

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Codeine/acetaminophen (Tylenol with Codeine Elixir)

 

Indicated for the treatment of mild to moderate pain. Contains codeine 12 mg and acetaminophen 120 mg per 5 mL.

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Contributor Information and Disclosures
Author

Itzhak Brook, MD, MSc  Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Ashir Kumar, MD, MBBS, FAAP  Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS, FAAP is a member of the following medical societies: American Association of Physicians of Indian Origin and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Gershon Segal, MD, to the development and writing of this article.

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Examination of the oropharynx demonstrates unilateral swelling and erythema of the left tonsil with deviation of the uvula to the contralateral side. Courtesy of Michael Altieri, MD, Medifor, Inc. Used with permission.
CT scan with contrast demonstrates a 2-cm low-attenuation mass with a minimally enhancing wall in the right peritonsillar region. Associated edema, ipsilateral jugulodigastric lymphadenopathy, compression of the internal jugular vein, and deviation of the airway are present.
 
 
 
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