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A systematic review of the role of penicillin versus penicillin plus metronidazole in the management of peritonsillar abscess

Published online by Cambridge University Press:  17 May 2023

C M Moen Open the ORCID record for C M Moen [Opens in a new window] ,
K Paramjothy ,
A Williamson ,
H Coleman ,
X Lou ,
A Smith  and
C M Douglas Open the ORCID record for C M Douglas [Opens in a new window]
C M Moen*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
K Paramjothy
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
A Williamson
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
H Coleman
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
X Lou
Affiliation:
Glasgow University Medical School, University of Glasgow, Scotland, UK
A Smith
Affiliation:
Department of Medical Microbiology, Glasgow Royal Infirmary, UK
C M Douglas
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK Glasgow University Medical School, University of Glasgow, Scotland, UK
*
Author for correspondence: Dr C M Moen, Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Govan, Glasgow G51 4TF, Scotland, UK E-mail: christy@moen.co.uk
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Abstract

Background

Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.

Methods

A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.

Results

Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.

Conclusion

Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.

Keywords

Palatine TonsilAbscessAntibacterial AgentsDrug ResistanceBacteria
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 9 , September 2023 , pp. 992 - 996
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

*

Equal first authors.

Dr Moen takes responsibility for the integrity of the content of the paper

Presented at the ENT Scotland Annual Summer Meeting, 12–13 May 2022, Dunblane, Scotland, UK.

References

Risberg, S, Engfeldt, P, Hugosson, S. Incidence of peritonsillar abscess and relationship to age and gender: retrospective study. Scand J Infect Dis 2008;40:792–6CrossRefGoogle ScholarPubMed
Galioto, NJ. Peritonsillar abscess. Am Fam Physician 2008;77:199–202Google ScholarPubMed
Johnson, MM. Ear, nose, and throat infections. In: Kradin, RL, ed. Diagnostic Pathology of Infectious Disease, 2nd edn. Philadelphia: Elsevier, 2018;118–42CrossRefGoogle Scholar
Chang, BA, Thamboo, A, Burton, MJ, Diamond, C, Nunez, DA. Needle aspiration versus incision and drainage for the treatment of peritonsillar abscess. Cochrane Database Syst Rev 2016;2016:CD006287Google Scholar
Klug, TE. Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess. Dan Med J 2017;64:B5333Google ScholarPubMed
Inman, JC, Rowe, M, Ghostine, M, Fleck, T. Pediatric neck abscesses: changing organisms and empiric therapies. Laryngoscope 2008;118:2111–14CrossRefGoogle ScholarPubMed
Ehlers Klug, T, Rusan, M, Fuursted, K, Ovesen, T. Fusobacterium necrophorum: most prevalent pathogen in peritonsillar abscess in Denmark. Clin Infect Dis 2009;49:1467–72CrossRefGoogle ScholarPubMed
Ryan, S, Papanikolaou, V, Keogh, I. Appraisal of the peri-hospital management and evolving microbiology of peritonsillar abscess disease. B-ENT 2014;10:15–20Google ScholarPubMed
Visvanathan, V, Nix, P. National UK survey of antibiotics prescribed for acute tonsillitis and peritonsillar abscess. J Laryngol Otol 2010;124:420–3CrossRefGoogle ScholarPubMed
Al Yaghchi, C, Cruise, A, Kapoor, K, Singh, A, Harcourt, J. Out-patient management of patients with a peritonsillar abscess. Clin Otolaryngol 2008;33:52–5CrossRefGoogle ScholarPubMed
Mazur, E, Czerwińska, E, Korona-Głowniak, I, Grochowalska, A, Kozioł-Montewka, M. Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis 2015;34:549–54CrossRefGoogle ScholarPubMed
Scott-Brown, WG, Gleeson, M. Scott-Brown's Otolaryngology, Head and Neck Surgery. London: Hodder Arnold, 2008Google Scholar
Ramirez, S, Hild, TG, Rudolph, CN, Sty, JR, Kehl, SC, Havens, P et al. Increased diagnosis of Lemierre syndrome and other Fusobacterium necrophorum infections at a children's hospital. Pediatrics 2003;112:e380CrossRefGoogle ScholarPubMed
Lemierre, A. On certain septicaemias due to anaerobic organisms. Lancet 1936;227:701–3CrossRefGoogle Scholar
Wikstén, JE, Pitkäranta, A, Blomgren, K. Metronidazole in conjunction with penicillin neither prevents recurrence nor enhances recovery from peritonsillar abscess when compared with penicillin alone: a prospective, double-blind, randomized, placebo-controlled trial. J Antimicrob Chemother 2016;71:1681–7CrossRefGoogle Scholar
Kieff, DA, Bhattacharyya, N, Siegel, NS, Salman, SD. Selection of antibiotics after incision and drainage of peritonsillar abscesses. Otolaryngol Neck Surg 1999;120:57–61CrossRefGoogle ScholarPubMed
Wiens, J, Snyder, GM, Finlayson, S, Mahoney, MV, Celi, LA. Potential adverse effects of broad-spectrum antimicrobial exposure in the intensive care unit. Open Forum Infect Dis 2018;5:ofx270CrossRefGoogle ScholarPubMed
Fair, RJ, Tor, Y. Antibiotics and bacterial resistance in the 21st century. Perspect Medicin Chem 2014;6:25–64CrossRefGoogle ScholarPubMed
Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:71CrossRefGoogle ScholarPubMed
Tunér, K, Nord, CE. Impact on peritonsillar infections and microflora of phenoxymethylpenicillin alone versus phenoxymethylpenicillin in combination with metronidazole. Infection 1986;14:129–33CrossRefGoogle ScholarPubMed
Yilmaz, T, Unal, OF, Figen, G, Akyol, MU, Ayas, K. A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses. Eur Arch Otorhinolaryngol 1998;255:163–5Google ScholarPubMed
Wexler, HM, Molitoris, E, Finegold, SM. Effect of beta-lactamase inhibitors on the activities of various beta-lactam agents against anaerobic bacteria. Antimicrob Agents Chemother 1991;35:1219–24CrossRefGoogle ScholarPubMed
Sterne, JAC, Savović, J, Page, MJ, Elbers, RG, Blencowe, NS, Boutron, I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials BMJ 2019;366:l4898CrossRefGoogle ScholarPubMed
Ottawa Hospital Research Institute. Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analysis. In: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp [20 December 2021]Google Scholar
Mehanna, HM, Al-Bahnasawi, L, White, A. National audit of the management of peritonsillar abscess. Postgrad Med J 2002;78:545–7CrossRefGoogle Scholar
Smith, A. Metronidazole resistance: a hidden epidemic? Br Dent J 2018;224:403–4CrossRefGoogle ScholarPubMed
World Health Organization. New report calls for urgent action to avert antimicrobial resistance crisis. https://www.who.int/news/item/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis [25 March 2023]Google Scholar
Hardingham, M. Peritonsillar infections. Otolaryngol Clin North Am 1987;20:273–8CrossRefGoogle ScholarPubMed