Approach to managing peritonsillar abscess and cellulitis

Monitor patients with peritonsillar abscess (quinsy) or cellulitis for signs of airway obstruction. If signs of airway obstruction are present, arrange urgent transfer to hospital with airway management.

Antibiotic therapy combined with drainage of the abscess (either incision and drainage, or aspiration) has traditionally been the mainstay of treatment for peritonsillar abscess; however, some experts now recommend medical therapy alone (antibiotics and corticosteroids). There is limited evidence to guide which patients may benefit from medical therapy alone, but abscess size and severity of illness should be considered. Medical therapy alone is not appropriate for patients with sepsis or septic shock, or airway compromise – for these patients, seek expert advice for management. Medical therapy alone is recommended when there is not a drainable source (ie patients with peritonsillar cellulitis). Closely monitor all patients who receive medical therapy without drainageBattaglia 2018Demongeot 2022Forner 2020Zebolsky 2021.