Metronidazole in conjunction with penicillin neither prevents recurrence nor enhances recovery from peritonsillar abscess when compared with penicillin alone: a prospective, double-blind, randomized, placebo-controlled trial

Abstract

For healthy adult PTA patients treated with incision and drainage, metronidazole neither prevents recurrence nor enhances recovery when combined with penicillin compared with penicillin alone, but instead leads to increased adverse effects.

Microbiological analysis and the outcomes of periodontal treatment with or without adjunctive systemic antibiotics—a retrospective study

“…However, antibiotics have side effects, e.g., 1-2% of individuals have allergy to penicillins [42], metronidazole was discussed having ototoxicity [43] and combined with penicillin it may cause nausea and diarrhea [44]. Moreover, the global problem of development of resistance associated with the consumption of antibiotics [45] demands a well indicated and very restricted use of these drugs [46].…”

Renewal of peritonsillar abscess: Impact of the bacterial species of the infection and clinical features of the patient—A prospective comparative aetiological study

“…As part of a previously published double‐blind randomised study with the identifier NCT01255670, the patients were then randomised to receive either penicillin and placebo or penicillin and metronidazole. Independent of the treatment, an equal amount of patients in both treatment groups experienced symptom renewal, nine in each group.…”

What antibiotic should be used in the management of an otherwise healthy adult with a peritonsillar abscess?

“…The bacteria identified range from group A streptococcus, anaerobic organisms, to several β‐lactamase–producing species . The studies we cite examined antibiotics as independent variables in the treatment of PTA, and all found that patients treated with drainage and penicillin alone had comparable outcomes to those treated with drainage and broad‐spectrum or multiple antibiotic regimens . The route of administration of penicillin appears to be based on patient compliance or inpatient routines, rather than evidence supporting IV versus oral effect on outcome.…”

“…1 The studies we cite examined antibiotics as independent variables in the treatment of PTA, and all found that patients treated with drainage and penicillin alone had comparable outcomes to those treated with drainage and broad-spectrum or multiple antibiotic regimens. [2][3][4][5] The route of administration of penicillin appears to be based on patient compliance or inpatient routines, rather than evidence supporting IV versus oral effect on outcome. It should also be noted that the earlier studies 2-4 may not have been sufficiently powered to find increases in treatment failures, if there were any.…”

“…Finally, in a double‐blind, randomized, placebo‐controlled trial (level 1b), Wikstén et al evaluated treatment outcomes after 10 days of oral penicillin combined with 7 days of placebo versus 10 days of oral penicillin combined with 7 days of oral metronidazole in an outpatient setting in patients who underwent incision and drainage of PTA. There were 100 patients in each study group.…”