For the empiric management of peritonsillar abscess, medical therapy alone may be an effective and safe alternative to surgical drainage, says a study published in the American Journal of Otolaryngology. Investigators undertook this study to investigate the use of medical therapy alone vs. surgical therapy in a consecutive cohort of patients treated for peritonsillar abscess.

Management strategies, demographics, treatment outcomes, and disease characteristics were compared between the groups. The major endpoints were therapy failure, defined as the requirement for follow-up surgical intervention, and the occurrence of complications within two weeks of therapy.

In total, 306 people (72.7%) underwent medical therapy alone, and 115 people (27.3%) underwent surgical therapy. No vital differences were reported in the rate of therapy failure between the two arms. Complications were noted to be rare in both medical therapy and surgical arms. Hospitalization, dysphagia, trismus, and larger abscesses were more common in the surgical therapy group. Corticosteroid prescriptions were found to be a common component of medical therapy alone and less commonly used with surgical therapy, as shown in Table 1:

Following adjustment for abscess size, no profound differences were noted in the rate of therapeutic failure between the groups. The univariate analyses showed no substantial independent predictors of therapy failure, including gender, age, race, history of tonsillitis and smoking, presenting signs and symptoms, abscess size, hospitalization, and prescription of corticosteroids.

The size of abscess size did not seem to affect therapy failure. But, careful patient selection is likely to optimize therapeutic outcomes. However, larger-scale prospective analyses are warranted, concluded the study authors.