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.