Medication Summary
Apart from drainage, antibiotics are a main component of therapy for peritonsillar abscesses.
Antibiotic therapy should begin prior to drainage and 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.
Antibiotics
Class Summary
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
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.
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.
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.
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.
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.
Corticosteroids
Class Summary
Corticosteroids may be indicated to decrease inflammation.
Dexamethasone (Baycadron, Decadron, Dexamethasone Intensol)
Dexamethasone, a potent glucocorticoid for which mineralocorticoid activity is minimal to absent, reduces inflammation through suppression of polymorphonuclear leukocyte (PMN) migration and reduction of capillary permeability. It also inhibits prostaglandin and proinflammatory cytokines.
Prednisone (Deltasone, Prednisone Intensol, Rayos)
Prednisone, a glucocorticoid with mild mineralocorticoid activity and moderate anti-inflammatory effects, reduces inflammation through suppression of polymorphonuclear leukocyte (PMN) migration and reduction of capillary permeability. It also inhibits prostaglandin and proinflammatory cytokines.
-
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.
