Current trend of antibiotic prescription and management for peritonsillar abscess: A cross‐sectional study

Abstract

Objective There are no consensus guidelines for managing peritonsillar abscess (PTA) despite its prevalence. In order to devise best practice guidelines, current practice patterns must first be established. Methods This was a cross‐sectional study, surveying Otolaryngology—Head & Neck Surgery trainees (residents and fellows) and consultant (academic and community). The primary outcome was the type and duration of outpatient antibiotic prescription. Secondary outcomes included differences in workup, management, prescription, and follow‐up. Results There were 57 respondents to the survey; 24 (42%) trainees (residents/fellows) and 33 (58%) consultants. On average, each respondent managed an average of 15.2 (SD 11.2) PTAs within the last year. All respondents prescribed oral antibiotics, with amoxicillin—clavulanic acid being the most common (61%). Trainees prescribed amoxicillin—clavulanic acid more often than consultants (n = 21, 88% vs n = 14, 42%, P = .0084), respectively. Duration of antibiotic therapy ranged from 5 to 14 days. Most commonly, a 10‐day course of antibiotics was prescribed (n = 31, 54%). Regarding the management of PTAs, a majority of respondents requested blood work (n = 39, 68%), performed needle aspiration (n = 42, 72%) and performed incision and drainage (n = 52, 91%). Culture and sensitivity of the aspirate/drainage fluid was frequently performed (n = 41, 72%). Patients were often provided non‐opioid analgesics (n = 46, 81%), but more than half still received prescription opioids (n = 36, 63%). The majority of clinicians arranged for follow‐up (n = 42, 74%), most often with Otolaryngology – Head & Neck Surgery (n = 27, 64%), with an average follow‐up of 12.5 (SD 8.2) days. Conclusion We found heterogeneity in the management of PTAs, with variability in the outpatient antibiotic prescription. This study highlighted the wide range of management strategies employed along with differences in workup, investigation, post‐discharge analgesic prescription, and follow‐up arrangements. Level of Evidence 5.

Disposal of unused antibiotics as household waste: A social driver of antimicrobial resistance

“…(2015) and Wu et al. (2021) who reported the duration of the antibiotics course was found to be in the range of 4–6 and 10 days in respective studies. In the present study, most of the people did not complete the course in the prescribed duration.…”

“…(2016) and Wu et al. (2021) while Deniz‐Sungur et al. (2020) reported that 90% of dentist prescribe amoxicillin for endodontic infections in Turkey.…”

Management of Peritonsillar Abscesses in Adults: Survey of Otolaryngologists in Canada and the United States

“…In a recent survey of trainees and consultants in Ontario, Canada, Wu et al 14 showed substantial variability in the management of uncomplicated PTA. The choice of antibiotic and duration of treatment varied, with 10-day courses of amoxicillin–clavulanic acid being the most common.…”

“…However, as outlined in our study, the overall use of imaging remains high, with most patients receiving imaging before consultation to otolaryngology–head and neck surgery actually occurs. Notably, Wu et al 14 highlighted the need for a large, international study to further characterize practice patterns for the purposes of informing contemporary practice guidelines. We have accomplished this goal with the current study of over 1000 otolaryngologists across Canada and the United States.…”

Peritonsillar and Intratonsillar Abscess: A Review on Clinical Features, Managements and Complications

“…Co-amoxiclav is the most prescribed antibiotic followed by clindamycin. Duration of antibiotics ranged from five to fourteen days with 10 days being most popular [22]. Many authors have recommended a broad-spectrum antibiotic with or without metronidazole or penicillin with a second antibiotic with b lactamase activity.…”