Peritonsillar abscess medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Prince Tano Djan, BSc, MBChB [2]

Overview

Medical therapy is the first liine treatment modality for peritonsillar abscess. Parenteral therapy is the preferred first line route of administration until the temperature of the patient has settled and clinically improved and then switched to oral therapy to complete a 14-day course.[1] The preferred emperic therapy is ampicillin-sulbactam with clindamycin as alternative agent. For resistant gram-positive cocci infections intravenous vancomycin or linezolid is added to the above emperic therapy.[2]

Medical therapy

Medical therapy is the first liine treatment modality for peritonsillar abscess.

Parenteral therapy is the preferred first line route of administration until the temperature of the patient has settled and clinically improved and then switched to oral therapy to complete a 14-day course.[1]

Antimicrobial Regimen

Below are the emperic antimicrobial regimen available in treating peritonsillar abscess.[2]

  • Preferred regimen in children: Ampicillin-sulbactam 50 mg/kg per dose [maximum single dose 3 g] IV 6h
  • Alternative regimen in adults: Clindamycin 600mg IV 6-8h
  • Alternative regimen in children: Clindamycin 13 mg/kg per dose [maximum single dose 900 mg] IV 8h

The above alternative therapy are employed in the following situations:

Pathogen-directed antimicrobial therapy

  • Resistant Gram-positive cocci

For resistant gram-positive cocci infections intravenous Vancomycin or linezolid is added to the above emperic therapy.

References

  1. 1.0 1.1 Apostolopoulos NJ, Nikolopoulos TP, Bairamis TN (1995). "Peritonsillar abscess in children. Is incision and drainage an effective management?". Int J Pediatr Otorhinolaryngol. 31 (2–3): 129–35. PMID 7782170.
  2. 2.0 2.1 Principles and Practice of Pediatric Infectious Diseases, 4th ed, Long SS, Pickering LK, Prober CG (Eds), Elsevier Saunders, New York 2012. p.205.

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