The management of peritonsillar sepsis by needle aspiration

Abstract

172 consecutive patients admitted with suspected unilateral peritonsillar sepsis were studied. Needle aspiration of the peritonsillar space was performed, and they were all then treated with intravenous antibiotics (usually benzylpenicillin). Any pus obtained was cultured. The aspiration was repeated if the patient was not improving after 24 h. A quantity of pus was aspirated at the first attempt from 91 patients (53%); 82 of these required no further aspiration but 7 required a further single aspiration and 2 required a further 2 aspirations before resolution of the sepsis. 71 of the 81 patients (88%) from whom pus had not been aspirated, and who were therefore initially considered to have peritonsillar cellulitis, required no further aspirations. However, 6 subsequently drained pus spontaneously and 4 produced a positive aspirate on a second occasion. Four patients required a change in their antibiotic therapy. We have found the combination of needle aspiration and parenteral antibiotics to be an effective treatment of peritonsillar sepsis. All patients were spared the unpleasant and painful experience of an incision and drainage procedure.

Gram Staining for the Treatment of Peritonsillar Abscess

“…Penicillins were the first choice of antibiotics in treating peritonsillar abscess [9, 14, 15]. Snow et al showed that penicillin is effective in the majority of cases and that it should be used as the initial antibacterial agent in nonallergic patients [14].…”

“…Snow et al showed that penicillin is effective in the majority of cases and that it should be used as the initial antibacterial agent in nonallergic patients [14]. Ophir et al assumed that removal of pus containing high levels of beta-lactamase enables the subsequently administered penicillin to eradicate the susceptible bacteria, thus accounting for the remarkably high success rate of using penicillin in their study in 1998 [16].…”

Indications for tonsillectomy stratified by the level of evidence

“…Because of the moderate quality of the identified studies, only answers with recommendation grade C could be given for questions 2 and 3. Among those 42 publications, there were only 5 level I trials [263], [304], [345], [363], [364], the remainder were classified as level IV including 13 case series with only one treatment modality [301], [302], [303], [305], [314], [343], [358], [374], [375], [376], [377], [378], [379], 12 case series comparing different therapies [261], [264], [307], [308], [366], [380], [381], [382], [383], [384], [385], [386], and one economic analysis [301]. Concerning recurrence rates and indication, the authors found 2 level II studies [309], [313] and 13 level IV trials [301], [303], [310], [311], [312], [314], [343], [350], [361], [372], [387], [388], [389].…”

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses

“…Snow et al [14,15] also indicate that the combination of needle aspirations with parenteral antibiotics is an effective treatment for peritonsillar sepsis, sparing patients the painful experience of an incision and drainage procedure. We believe that incision and drainage are no more unpleasant or painful than needle aspiration and that incision and drainage take only a few seconds to accomplish, whereas needle aspirations may be more time-consuming and require repeat aspirations.…”