Peritonsillar abscess

Background

• Abscess between tonsillar capsule and superior constrictor muscle
• Etiology
  • Strep/staph, anaerobes, eikenella, haemophilus
• <10% bilateral

Diagnosis

Presentation

• Sore throat, fever trismus, voice change, uvular devation (away from abscess)

Imaging

• May be needed to differentiate tonsillitis from abscess
• CT
  • Consider if:
    • I&D failed
    • Pt uncooperative (trismus, peds)
• Ultrasound
  • Sn 95.2%, Sp 78.5%

Treatment

1. Needle aspiration versus I&D
2. Abx
   1. Outpatient
      1. Amoxicillin/clavulanate 875 mg PO BID x 7-10d OR
      2. Clindamycin 600-900 mg PO TID x7-10d OR
   2. Inpatient
      1. Ampicillin/Sulbactam 3 gm (75mg/kg) IV QID OR
      2. Pipericillin/Tazobactam 4.5 gm IV TID OR
      3. Ticarcillin/Clavulanate 3.1 g IV QID OR
      4. Clindamycin 600-900mg IV TID
3. Steroids
   1. Dexamethasone 10mg PO/IM x1