Introduction
Peritonsillar abscess, commonly called a quinsy, is a collection of pus
between capsule of the palatine tonsil and the superior constrictor
muscle. It’s anterior and posterior boundaries are formed by the
palatoglossus, and palatopharyngeus, respectively. It is the most common
deep neck space infection, with previous studies showing an estimated
incidence of 37/100,000.1 Peritonsillar abscess
primarily affects young adults during the months of April to May and
November to December, when exudative tonsillitis and streptococcal
pharyngitis are at their peak.2 Symptoms of this
condition include sore throat and otalgia on the affected side, trismus,
malaise, halitosis and fever.3 Clinical signs on
examination include swelling and erythema of the soft palate on the
affected side with deviation of the uvula to the contralateral side,
trismus and cervical lymphadenopathy. Management of a quinsy involves
aspiration of the abscess and administration of
antibiotics.4 Cultures of the aspirated pus commonly
produce polymicrobial growth of gram positive and gram negative
bacteria, including aerobes (e.g. Streptococcus pyogenes) and
anaerobes (e.g Fusobacterium spp ).5–7 As a
result many institutions prescribe antibiotics such co-amoxiclav, or
metronidazole in addition to the traditional narrower spectrum
antibiotics like phenoxymethylpenicillin for fear of
under-treating.8–12 The proposed rationale for
prescribing these broader spectrum antibiotics is primarily to prevent
complications secondary to the gram negative anaerobe,Fusobacterium necrophorum such as Lemierre’s
syndrome.7,13 First described in 1936, Lemierre’s
syndrome consists of a bacteraemia with thrombophlebitis of the internal
jugular vein, which can also result in septic
emboli.14 However little evidence exists to support
the use of penicillin plus additional anaerobic cover in the management
of peritonsillar abscess.15,16 Furthermore, their
prescription is not without potential complication. Agents with a
broader spectrum of activity are known to have increased side effects
plus their use increases the incidence and prevalence of antibiotic
resistant organisms.17,18
The aim of this systematic review is to assess penicillin (or allergy
alternative) vs penicillin (or allergy alternative) plus anaerobic cover
in the management of peritonsillar abscess.