Implications for future clinical practice and research
The reviewed evidence suggests that in the presence of effective
drainage of the peritonsillar abscess single agent oral phenoxymethyl
penicillin is not associated with adverse clinical outcomes. There is no
evidence to suggest benefit of administration of metronidazole in the
management of quinsy. As such, clinicians should avoid prescribing
additional metronidazole in this clinical setting. Some
studies have suggested the addition of metronidazole if no clinical
improvement after 24 hours.29Only three studies were
included in this systematic review. Further research into penicillin
alone (or equivalent pen allergic) versus penicillin plus additional
anaerobic cover using updated dosing schedules is needed.