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Published on: November 6, 2019
Peritonsillar abscess in children: A retrospective analysis on surgical and antimicrobial approaches
Stefan Alexander Rudhart1, Thorsten Send1, Maike Tilk1
1Department of Otorhinolaryngology, University Medical Center Bonn, Bonn, Germany.
Insights
Pediatric peritonsillar abscess (PTA) surgery comparing unilateral tonsillectomy (UTE) and bilateral tonsillectomy (BTE) showed similar complication rates. Antibiotic therapy, particularly Ampicillin-Sulbactam, aligns with microbiological findings for effective PTA treatment.
Area of Science:
- Otorhinolaryngology
- Pediatric Infectious Diseases
- Surgical Treatment
Background:
- Peritonsillar abscess (PTA) is a common infection in children, with potential for severe complications.
- Surgical intervention is a key treatment modality for pediatric PTA.
- Understanding surgical risks and microbiological profiles is crucial for optimal patient outcomes.
Purpose of the Study:
- To investigate surgical treatments for pediatric peritonsillar abscesses.
- To compare complication risks between unilateral tonsillectomy (UTE) and bilateral tonsillectomy (BTE).
- To evaluate intraoperative microbiological smears and antibiotic therapy coverage.
Main Methods:
- Retrospective analysis of 150 pediatric patients treated for PTA between 2009 and 2024.
- Comparison of UTE versus BTE, analyzing bleeding risk, complications, and recurrence rates.
- Assessment of microbiological flora and antibiotic treatment efficacy.
Main Results:
- No significant difference in postoperative bleeding between UTE and BTE groups.
- Recurrent PTA occurred in 4.4% of UTE patients; no other severe complications were noted.
- Antibiotic choices (Cefuroxime, Ampicillin-Sulbactam) correlated with detected microbial flora.
Conclusions:
- UTE and BTE demonstrate comparable complication rates in pediatric PTA management.
- Broad-spectrum antibiotics effectively cover the identified microbiological spectrum.
- Ampicillin-Sulbactam has been the preferred antibiotic therapy for pediatric PTA since 2019.
Background:
Peritonsillar abscess (PTA) is a prevalent infection for specialists in otorhinolaryngology and pediatric primary care providers, that has the potential to cause severe complications. The aim of this study is to investigate the surgical treatment of pediatric peritonsillar abscesses and to compare the risk profiles of bilateral surgery versus surgery on the affected side alone. In addition, the evaluation of the microbiological smears obtained intraoperatively should provide information on whether the calculated antibiotic therapy adequately covers the microbial spectrum.
Methods:
We conducted a retrospective analysis of pediatric patients (n = 150), who were treated for PTA between 2009 and 2024 by unilateral tonsillectomy (UTE) or bilateral tonsillectomy (BTE). Patient charts were analyzed regarding risk of bleeding, occurrence of other complications, recurrence rates in case of UTE as well as microbiological flora and antibiotic treatment.
Results:
Postoperative bleeding did not differ significantly between both groups. In 4.4% of the patients treated by UTE a recurrent PTA was found. No other severe complications after surgical treatment were found. Antibiotic treatment mainly relied on Cefuroxime and Ampicillin-Sulbactam, which is in accordance with the detected microbiological flora.
Conclusions:
No relevant differences were found with regard to the complication rate between UTE und BTE in pediatric patients. Broad-spectrum antibiotics were used in accordance with the detected microbiological flora. Since 2019, calculated antibiotic therapy with Ampicillin-Sulbactam has been the treatment of choice for pediatric PTA.
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