Peritonsillar Abscess (Quinsy)

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Introduction

  • It is a common local complication of acute tonsillitis whereby a virulent streptococcal infection spread beyond the tonsillar capsule into the peri-tonsillar space, causing, first cellulitis, and later suppuration in the space
  • More common in adults with tonsillitis

Clinical features

  • Follows an attack of acute tonsillitis
  • Increasing pain, fever and dysphagia
  • Trismus- spread of oedema and infection to pterygoid muscles
  • Often referred pain to ipsilateral ear
  • Difficulty in opening mouth for examination; mouth full of saliva
  • Affected tonsil displaced downwards and medially, with swelling above and lateral to it, all inflamed and oedematous
  • Uvula pushed to opposite side

Differential diagnoses

  • Parapharyngeal abscess
  • Retropharyngeal abscess
  • Tonsillar tumours

Complications

  • Septicaemia
  • Parapharyngeal suppuration/abscess

Investigations

  • Throat swab
  • Full Blood Count with differentials

Treatment goals

  • Rapid control of infection
  • Relief of pain and discomfort

Non-drug treatment

  • Improves
  • Incision and drainage, preferably under local anaesthetic when suppuration is definite

Drug treatment

  • Antibiotics
    • Amoxicillin
    • Adult: 500 mg -1 g intravenously every 6 hours for 7 days
    • Child: 50 - 100 mg/kg orally every 8 hours
  • Analgesics
    • Paracetamol
    • Adult: 500 mg - 1 g orally every 4 - 6 hours (maximum of 4 g daily) for 5-7 days
    • Child over 50 kg: same as adult dosing
    • 6 - 12 years: 250 - 500 mg;
    • 3 months - 5 years: 125 – 250 mg taken orally 4 - 6 hourly for 5 - 7 days
  • Or:
    • Aspirin (Acetylsalicylic acid)
      • Adult: 300 - 900 mg orally every 4 - 6 hours when necessary; maximum 4 g daily
      • Not recommended in children (risk of Reye's syndrome)

Supportive measures

  • Intravenous infusion
  • Bed rest

Notable adverse drug reactions

  • Aspirin may cause gastrointestinal irritation

Prevention

  • Elective tonsillectomy is advised after an episode of quinsy to prevent further (more severe) attacks