What Are Practice Patterns in Peritonsillar Abscess Management?

by Linda Kossoff •

What are the current practice patterns for managing peritonsillar abscess (PTA) that could ultimately be used to devise best practice guidelines?

BOTTOM LINE

Current heterogeneity in PTA management includes differences in workup, investigation, and post-discharge analgesic prescription, as well as variability in outpatient antibiotic prescriptions.

BACKGROUND: Peritonsillar abscess represents the most common infection of the deep neck space. If left untreated or inadequately treated, PTAs can spread to adjacent deep neck spaces and cause life-threatening conditions. Although PTA management has evolved in recent years, there still are no consensus guidelines based on current management patterns.

STUDY DESIGN: Cross-sectional study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.

SYNOPSIS: Researchers administered a 20-question survey on management of an uncomplicated PTA to Otolaryngology–Head & Neck Surgery (OHNS) trainees and consultants. Fifty-seven respondents completed the survey. Primary outcome measure was the type and duration of outpatient antibiotic prescribed. Secondary outcome measures focused on PTA management: manual palpation, nasolaryngoscopy, imaging, bloodwork, intravenous (IV) antibiotics, IV steroids, drainage techniques, culture and sensitivity of aspiration/drainage, prescription of analgesics, opioids and oral steroids, and follow-ups. Although all respondents were prescribed oral antibiotics for outpatient management, antibiotic type was divided between amoxicillin-clavularic (61%) and clindamycin (35%); course duration ranged from five to 10 days. Opioids and non-opioids were prescribed at 63% and 81%, respectively; oral steroids were less common (16%). Needle aspiration, and incision and drainage were commonly performed (72% and 91%, respectively) although fewer respondents (31%) reported performing only incision and drainage if needle aspiration was positive for purulence. Most respondents provided IV antibiotics (77%) and/or IV steroids (75%). Study limitations included low rates of survey response and the potential for recall bias and volunteer bias.

CITATION: Wu V, Kolarski MM, Kandel CE, et al. Current trend of antibiotic prescription and management for peritonsillar abscess: A cross-sectional study [published online ahead of print March 11, 2021]. Laryngoscope Investig Otolaryngol. doi:10.1002/lio2.538.