Peritonsillar abscess (Quinsy)

Introduction

Peritonsillar abscess is the main common local complication of acute tonsillitis in which the infection spreads behind the tonsils.
It is a virulent streptococcal infection; it may spread beyond the tonsillar capsule into the peri-tonsillar space, causing, first cellulitis,  and later suppuration in the space.
It is more common in adults with tonsillitis.

Symptoms and Clinical features of Peritonsillar abscess (Quinsy)

Follows an attack of acute tonsillitis

  1. Increasing pain, fever and dysphagia
  2. Trismus- spread of oedema and infection to pterygoid muscles
  3. Often referred pain to ipsilateral ear
  4. Difficulty in opening mouth for examination; mouth full of saliva
  5. Affected tonsil displaced downwards and medially, with swelling above and lateral to it, all inflamed and oedematous
  6. Uvula pushed to opposite side

Differential diagnoses

  • Parapharyngeal abscess
  • Retropharyngeal abscess
  • Tonsillar tumours

Complications of Peritonsillar abscess (Quinsy)

  • Septicaemia
  • Parapharyngeal
  • suppuration/abscess

Investigations

  • Throat swab
  • Full Blood Count with differentials

Treatment for Peritonsillar abscess (Quinsy)

Treatment objectives

  • Rapid control of infection
  • Relief of pain and discomfort

Non-drug treatment

  • Incision and drainage, preferably under local anaesthetic when suppuration is definite

Drug treatment

A. Antibiotics

Amoxicillin

  • Adult: 500 mg -1 g intravenously every 6 hours for 7 days
  • Child: 50-100 mg/kg orally every 8 hours

B. Analgesics

Paracetamol

  • Adult: 500 mg-1 g orally every 4-6 hours (to a maximum of 4 g) for 5-7 days
  • Child:
    • over 50 kg: same as adult dosing
    • 6-12 years: 250-500 mg;
    • 3 months – 5 years: 125-250 mg taken orally 4-6 hourly for 5-7 days

Or:

Aspirin (Acetysalicylic acid)

  • Adult: 300 – 900 mg orally every 4 – 6 hours when necessary; maximum 4 g
  • Not recommended in children (risk of Reye’s syndrome)

Supportive measures

  • Intravenous infusion
  • Bed rest

Notable adverse drug reactions

  • Aspirin may cause gastrointestinal irritation

Prevention of Peritonsillar abscess (Quinsy)

  • Elective tonsillectomy is advised after an episode of quinsy to prevent further (more
    severe) attacks