J36
DESCRIPTION
Peritonsillar abscess or quinsy is a collection of pus lateral to the tonsil, i.e. underneath it pushing it toward the midline. Infections are often polymicrobial. It typically presents with trismus and sore throat. Other features include:
- unilateral throat pain
- dysphagia
- drooling
- muffled voice
- fever
SURGICAL MEASURES
Drainage of pus is the most important intervention.
There are 3 main methods:
- needle aspiration of pus;
- incision and drainage;
- abscess tonsillectomy, either unilateral or bilateral.
MEDICINE TREATMENT
Antibiotic therapy
Total duration of therapy: 10 days.
- Amoxicillin/clavulanic acid, IV, 1.2 g 8 hourly.
Follow with oral therapy as soon as patient can swallow and the temperature is <37.8oC for 24 hours:
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly.
Severe penicillin allergy: (Z88.0)
- Clindamycin, IV, 600 mg 8 hourly.
Follow with oral therapy as soon as patient can swallow and the temperature is <37.8oC for 24 hours:
- Clindamycin, oral, 450 mg 8 hourly.
For pain:
- NSAID, oral: e.g.
- Ibuprofen, oral, 400 mg 8 hourly with or after meals.
REFERRAL
Referral for ENT and/or anaesthetic review:
Urgent
- Signs of airway compromise (e.g. stridor).
- Suspicion of infective spread beyond the peritonsillar space.