ear, nose, and throat disorders
Peritonsillar Abscess and Cellulitis
Treatment
Antibiotics Drainage of abscess Cellulitissubsides, usually within 48 hours, with hydration and high-dose penicillin (eg, 2 million units IV every 4 hours or 1 g orally 4 times a day); alternative drugs include a 1st-generation cephalosporin orclindamycin. Culture-directed antibiotics are then prescribed for 10 days. Abscessesare incised and drained in the emergency department using thorough local anesthesia and sometimes procedural sedation; many clinicians believe needle aspiration alone provides adequate drainage. Ultrasound guidance is sometimes used when the diagnosis of abscess is unclear or when the abscess is small (<1 cm). Although most patients can be treated as outpatients, some need brief hospitalization for parenteral antibiotics, IV hydration, and airway monitoring. Rarely, an immediate tonsillectomy is done, particularly in a young or uncooperative patient who has other indications for elective tonsillectomy (eg, history of frequently recurrent tonsillitis or obstructive sleep apnea). Otherwise, if patients have also had recurrent tonsillitis, elective tonsillectomy is done 4 to 6 weeks later to prevent abscess recurrence. 