Outcomes of conservative antibiotic therapy in pediatric peritonsillar abscesses: a retrospective observational study

Peritonsillar abscess (PTA) is a common deep neck infection in adolescents and young adults, traditionally treated surgically. This study evaluates the efficacy and safety of conservative management with antibiotics for PTA in pediatric patients. We designed a retrospective observational study at a tertiary care center to analyze the outcome of children under the age of 18 years managed conservatively for PTA from 2004 to 2014. The main outcome was primary treatment failure, defined as the need for surgery or complications within 2 weeks. Secondary outcomes included secondary failure (recurrence or complication more than two weeks after hospital admission) and overall failure (primary or secondary). Of 107 patients, 93 (87%) underwent conservative management with a 6.4% (6/93) primary failure rate requiring surgery and no complications reported. Older age and severe symptoms (e.g., respiratory distress, trismus) correlated with higher failure risk. Secondary failure occurred in 9 patients (9.6%), with recurrences spanning up to 8 years. Overall failure rate was 16.1%, predominantly affecting older children with an adjusted odds ratio per 1-year increase of 1.19 (95% CI 1.03-1.42; p = 0.03).

Our findings suggest that conservative management of pediatric PTA with antibiotics is a safe and effective approach in selected cases. While most patients respond to antibiotics alone, careful monitoring may be warranted for older children or those with more severe presentations.

• Surgical management is the gold standard for pediatric peritonsillar abscess (PTA). • Antibiotic-only treatment is an emerging alternative in selected patients.

• This study supports conservative management as safe and effective. • Long-term follow-up confirms low failure and complication rates, especially in younger, less symptomatic children.