Out‐patient management of patients with a peritonsillar abscess

Abstract

In the United Kingdom, patients with a peritonsillar abscess are usually managed as inpatients. However, studies in other countries have shown successful management of these patients as outpatients. We designed an evidence based protocol for the management of patients with a peritonsillar abscess. Diagnosis was by aspiration of pus. Initial treatment was with analgesia, 1.2 g co-amoxiclav and 4 mg dexamethasone intravenously. Data were collected prospectively over 11 months on the management of all patients who had been confirmed by aspiration of pus to have a peritonsillar abscess. Four of the 46 patients (9%) treated as per the protocol required admission, two immediately and two later on. Of the 44 patients initially treated as outpatients, 41 said they were happy to have been treated as outpatients and not admitted to hospital (93%). Patients with a peritonsillar abscess can be managed successfully as outpatients with a high degree of patient satisfaction.

The epidemiology, antibiotic resistance and post-discharge course of peritonsillar abscesses in London, Ontario

“…This could be important, as a trend towards increasing anaerobic growth rates has been identified in Israel, increasing from 6.8% to 37% over three years and anaerobic presence has been shown to be a risk factor for recurrence [11,12]. Both the number of patients requiring hospitalization and the number of patients requiring re-aspiration was consistent with what has been reported previously in the literature, with past numbers for admission ranging from 3–14% and from 4–16% for re-drainage [1,13,14]. …”

An evidence‐based review of peritonsillar abscess

“…These studies cite low readmission (2%) and absent complications as evidence of effective outpatient management (evidence level 3) 25,26,37 . In the UK, a prospective study of 46 patients showed successful outpatient management with a readmission rate of 5% and, importantly, high levels of patient satisfaction (evidence level 3) 46 …”

“…Comorbidity, immunocompromise and age >40 years are further risk factors for the complications of peritonsillar abscess 47 . Short‐term monitoring bays, patient information protocols and if required follow‐up systems, all need to be set up within the department before outpatient management can successfully be implemented 46 …”

Re: Out‐patient management of patients with a peritonsillar abscess

“…As to your second concern that we boldly stated 'the amount of pus aspirated does not correlate to [sic] re-accumulation' I can reassure you that if you re-read our article you will notice that we did not in fact make that statement. 2 The two patients who required re-aspiration initially had 1 and 9 mL aspirated. Thirty five of the patients we treated as outpatients had 3 mL or more of pus aspirated, but only one of these returned for re-aspiration.…”

“…2 2 While the retrospective power calculation by Loock and Naude demonstrated that an extremely large number of patients are required to achieve significance, the 12-year gap between data collection and publication could have allowed for greater recruitment or involvement of other centres to increase numbers. 2 2 While the retrospective power calculation by Loock and Naude demonstrated that an extremely large number of patients are required to achieve significance, the 12-year gap between data collection and publication could have allowed for greater recruitment or involvement of other centres to increase numbers.…”