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Treatment of Peritonsillar Abscess in Children: A Systematic Review
Francesca Galluzzi1, Werner Garavello1,2
1Department of Otorhinolaryngology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy.
Insights
The primary treatment for pediatric peritonsillar abscess (PTA) involves antibiotics combined with incision and drainage. Alternative options like antibiotics alone or with needle aspiration are also discussed for managing this common childhood infection.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Surgical Management
Background:
- Peritonsillar abscess (PTA) is a common complication of tonsillitis in children.
- Effective management strategies are crucial to prevent recurrence and complications.
Purpose of the Study:
- To systematically review and analyze current treatment modalities for pediatric peritonsillar abscess.
- To evaluate the efficacy and recurrence rates associated with different PTA treatment options in children.
Main Methods:
- A comprehensive literature search was conducted on PubMed and EMBASE databases.
- Studies were selected and reviewed following PRISMA guidelines for systematic reviews.
- Qualitative and quantitative analyses were performed on data from 12 retrospective cohort studies involving 2211 pediatric cases.
Main Results:
- Broad-spectrum antibiotic therapy with incision and drainage was the most frequent treatment (69%).
- Antibiotics alone were used in 16.4% of cases, while needle aspiration and immediate tonsillectomy were less common (7.6% and 7%, respectively).
- PTA recurrence rates ranged from 2% to 15.8%, typically occurring within one to two months; complications included torticollis, prolonged fever, sepsis, dyspnea, and parapharyngeal involvement.
Conclusions:
- Antibiotic therapy combined with incision and drainage remains the standard treatment for pediatric PTA.
- Antibiotic treatment alone or with needle aspiration serves as viable alternatives.
- Immediate tonsillectomy is reserved for select high-risk pediatric patients with PTA.
Abstract:
Objectives: This review aims to analyze the treatment options for peritonsillar abscess (PTA) in children. Methods: We searched PubMed and EMBASE for studies regarding the treatment of PTA in children. Relevant studies were reviewed based on systematic review (PRISMA) guidelines. Qualitative and quantitative analyses of the extracted data were performed. Results: A total of 12 articles with 2211 cases of PTA were found to be eligible. All the identified studies were retrospective cohorts. The mean age varied from 8.5 to 15.4 years without gender difference. Treatment options included broad-spectrum antibiotic therapy with incision and drainage of the abscess, needle aspiration and immediate tonsillectomy in 69%, 7.6% and 7% of cases, respectively. Antibiotics alone were administered to 16.4% of the subjects. The rate of recurrence of PTA after primary treatment ranged from 2% to 15.8% of cases. The time of recurrence is considered within one or two months. Complications in children with PTA were torticollis, prolonged fever, sepsis, dyspnea and parapharyngeal involvement. Conclusions: The mainstay of treatment of PTA in children is antibiotic therapy with incision and drainage of the abscess. Alternatives include antibiotic treatment alone or in association with needle aspiration. Immediate tonsillectomy is reserved only for a few high-risk patients.
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