Infectious Disease Compendium

Peritonsillar Abscess aka Quinsy

Diagnosis

Fevers, toxicity, severe pain and dysphagia; marked asymmetry of retropharynx on exam. CT makes the diagnosis.

Epidemiologic Risks

Streptococcal pharyngitis

NSAIDs are a risk as well (Pubmed).

Microbiology

Group A streptococci and other mouth organisms.

Empiric Therapy

Drain it then penicillin or any other beta-lactam will nuke a group A strep.

Initially overtreat until cultures back as could be a mixed infection: (third generation cephalosporins PLUS metronidazole ) OR penicillin/beta-lactamase inhibitors OR (quinolone PLUS metronidazole OR clindamycin) OR carbapenems.

Dexamthasone 10 mg iv single dose led to a more rapid symptomatic improvement without complications (PubMed).

Pearls

Rants