Conclusions
Peritonsillar abscess is an extremely common ENT condition, and as such
appropriate safe and effective management is critical. Current evidence
suggests no clinical benefit for the routine administration of
additional anaerobic cover (Metronidazole) to oral phenoxymethyl
penicillin as part of the treatment of peritonsillar abscess. The use of
single agent oral phenoxymethyl pencillin is effective and avoids the
use of additional anaerobic cover reducing costs in healthcare systems,
as well as reduced pressure to develop antimicrobial resistance.
Key Points
- Peritonsillar abscess is a common deep neck space infection.
- Pus from the abscess is often polymicrobial, and usually contain
anaerobes.
- Single agent oral Phenoxymethyl pencillin provides a safe and
effective clinical outcome in the outpatient setting and as part of
surgical management of the peritonsillar abscess
- Many clinicians prescribe metronidazole as well as a penicillin or an
allergy alternative. There is no evidence to suggest additional
benefit by adding metronidazole, with some studies suggesting
increased side effects
- More work is required to strengthen the evidence base on single narrow
spectrum agent prescribing for optimum dose, frequency and duration of
treatment