## Peritonsillar Abscess: Microbiology and Management **Key Point:** Peritonsillar abscess requires both microbiologic coverage and drainage. Needle aspiration is a safe, effective diagnostic and therapeutic procedure that can be performed under local anesthesia in cooperative patients. ### Microbiology | Organism Type | Frequency | Common Species | |---|---|---| | **Aerobic** | ~60–70% | Group A Streptococcus (most common), S. aureus, Streptococcus pneumoniae | | **Anaerobic** | ~40–50% | Peptostreptococcus, Prevotella, Fusobacterium, Bacteroides | | **Mixed infections** | Common | Aerobic + anaerobic polymicrobial | **High-Yield:** Peritonsillar abscess is often a **polymicrobial infection** with both aerobes and anaerobes. Culture is important but empiric therapy must cover both. ### Drainage Procedures | Procedure | Setting | Indication | Safety | |---|---|---|---| | **Needle aspiration** | Local anesthesia (outpatient) | Diagnostic + therapeutic; cooperative patient | Safe, effective, well-tolerated | | **Incision & drainage (I&D)** | Local or general anesthesia | Larger abscess, recurrent, failed aspiration | Requires adequate airway control | | **Tonsillectomy** | General anesthesia (OR) | Recurrent abscess, chronic tonsillitis | Definitive but more morbid | **Clinical Pearl:** Needle aspiration under topical/local anesthesia is the **first-line drainage procedure** in most cases. It is safe, diagnostic (allows culture), and therapeutic. General anesthesia is NOT required for uncomplicated cases. **Warning:** The statement "needle aspiration is contraindicated" is FALSE. This is a common misconception. Needle aspiration is safe and preferred in cooperative patients because it avoids the risks of general anesthesia. ### Antibiotic Therapy 1. **Empiric regimen** (pending culture): - Amoxicillin-clavulanate (covers aerobes + anaerobes) - OR Clindamycin (excellent anaerobic coverage) - OR Cephalosporin + metronidazole 2. **Duration:** 10–14 days 3. **Culture-directed therapy:** Adjust based on sensitivities once results available **High-Yield:** Empiric therapy MUST cover both aerobic and anaerobic organisms because mixed infection is the norm.
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.