Nelson Textbook of Pediatrics 22nd Edition | Complication of acute tonsillitis (usually GAS). Clinical: trismus, muffled voice, asymmetric tonsil bulge with uvular deviation. Diagnosis clinical; intraoral ultrasound or CT if unclear. Microbiology: GAS, oral anaerobes, S. aureus. Treatment: needle aspiration or incision & drainage + IV antibiotics (ampicillin-sulbactam, clindamycin). Tonsillectomy for recurrent cases. Complications: airway obstruction, rupture, aspiration, spread to parapharyngeal space, Lemierre syndrome.
🌐 paeds.online — Pakistan's Pediatric Platform| Treatment Option | Indication | Details |
|---|---|---|
| Needle aspiration (superior, middle, inferior) | First-line for uncomplicated PTA (≥95% success) | Topical anesthesia/conscious sedation. Aspirate pus for culture. Repeat if needed. |
| Incision & drainage (I&D) | Failed needle aspiration, recurrent, or large abscess | Make incision over maximal bulge, spread with hemostat. Can be done in ED/OR. |
| Quinsy tonsillectomy (immediate) | Recurrent PTA, history of recurrent tonsillitis, failed drainage, severe trismus | Definitive procedure. Higher bleeding risk but eliminates recurrence. |
| Medical management (antibiotics alone) | Early peritonsillar cellulitis (phlegmon), no discrete abscess, mild symptoms | IV ampicillin-sulbactam or clindamycin. Discharge only if improving, tolerating PO. |