Peritonsillitis in primary care: patient characteristics and care pathways - a population-based registry study

Peritonsillitis, including peritonsillar abscess and cellulitis, is a common deep neck infection often considered a complication of pharyngotonsillitis. However, population-based data on patient characteristics, clinical presentation, and care pathways are limited.

We conducted a population-based registry study in Region Kronoberg, Sweden (2012-2016), including all episodes of peritonsillitis and pharyngotonsillitis diagnosed in primary health care (PHC) and hospitals. New episodes were defined as diagnoses separated by ≥ 30 days. Patient characteristics, recent pharyngotonsillitis, and referral pathways between PHC and specialist care were described. Incidence rates and temporal trends were estimated to provide population context.

A total of 607 peritonsillitis episodes were identified in 555 patients. Incidence peaked in late adolescence and young adulthood, remained low in children and older adults, and showed no sex differences within age groups. Only 23% of episodes were preceded by pharyngotonsillitis within 30 days (median interval: 2 days), increasing to 29% when restricting the analysis to cases confirmed in the ear, nose, and throat (ENT) department. Most patients (74%) were first diagnosed in PHC, and 71% of these were subsequently managed in the ENT department. Overall, 85% of all episodes involved initial PHC management. Incidence of peritonsillitis declined over time in parallel with pharyngotonsillitis at the population level.

Peritonsillitis predominantly affects adolescents and young adults and commonly presents without a recent documented sore throat. PHC plays a central role in initial assessment and referral, with most patients subsequently managed in specialist care. These findings provide population-level insights into patient characteristics and care pathways, with implications for early recognition and management in PHC.