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Peritonsillar abscess in children. Is incision and drainage an effective management?
N J Apostolopoulos1, T P Nikolopoulos, T N Bairamis
1ENT Dept., P. and A. Kyriakou Children's Hospital, Thibon and Lebadias, Athens, Greece.
Insights
Peritonsillar abscess (PA) in children is effectively managed with incision and drainage without general anesthesia. Extended oral antibiotics post-discharge may reduce recurrence, making tonsillectomy less necessary.
Area of Science:
- Otolaryngology
- Pediatric Infectious Diseases
- Surgical Management
Background:
- Peritonsillar abscess (PA) management in children remains a topic of debate.
- Effective treatment strategies are crucial for pediatric patients to minimize complications and recurrence.
Purpose of the Study:
- To evaluate the efficacy and safety of incision and drainage (I&D) without general anesthesia for pediatric peritonsillar abscess.
- To assess the recurrence rate of PA in children and identify factors influencing it.
- To provide evidence-based recommendations for the management and follow-up of pediatric PA.
Main Methods:
- A retrospective study of 189 children diagnosed with PA over seven years.
- Management included incision and drainage (92.5% without general anesthesia) and intravenous antibiotics.
- Follow-up data from 101 children were analyzed for recurrence rates and timing.
Main Results:
- The majority of children experienced resolution without complications following I&D and antibiotics.
- The recurrence rate was 15.8%, with 47% occurring within one month of discharge.
- Predominant bacterial isolates included Streptococcus spp. (55%), anaerobes (12%), and Staphylococcus aureus (6%).
Conclusions:
- Incision and drainage without general anesthesia is an effective and applicable treatment for pediatric PA.
- The recurrence rate suggests that some cases may be persistent, warranting extended oral antibiotic therapy post-discharge.
- Peritonsillar abscess is not a strong indication for tonsillectomy in children due to a relatively low recurrence rate; close follow-up is recommended.
Abstract:
Debate continues concerning proper management of peritonsillar abscess (PA). We studied 189 children (mean age, 9 years) admitted in our department during the last 7 years with the diagnosis of PA. Management consisted of incision and drainage (performed in 92.5% of the children without general anaesthesia) and antibiotic therapy intravenously. There was resolution without complications in the overwhelming majority of the cases. After the initial episode, we further followed up 101 children. The recurrence rate was 15.8%. Forty-seven percent of the recurrences occurred 1 month after the children had been discharged. Probably some of these second PA should be considered as persistent and not as recurrent. Therefore, we propose that after their discharge, the children must take oral antibiotics (resistant to beta-lactamase) for more than 10 days. Cultures were taken from 58 cases. The predominant bacterial isolates were Streptococcus spp. (55%), anaerobes spp. (12%) and Staphylococcus aureus (6%). To our knowledge, this is the first survey that addresses exclusively a pediatric population and suggests that incision and drainage without general anaesthesia is an applicable and effective management in children with PA. Moreover, we believe that peritonsillar abscess is no longer a strong indication for tonsillectomy due to the relatively low rate of recurrence. We recommend close follow-up, mainly for the first months after the initial episode.