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.