Variations in treatment of peritonsillar abscess in four Nordic countries

Abstract

A total of 73 physicians (90%) replied. The largest differences arose in treating patients with intravenous versus per oral antibiotics, and treating as inpatients versus outpatients. In Finland, 50% of PTA patients aged >16 years were treated as inpatients and 50% as outpatients, whereas the respective quotas in Sweden were 9 and 91%, Norway 19 and 81%, and Denmark 33 and 67%. Of Finnish physicians, 30% treated their patients primarily with oral antibiotics, 70% with intravenous antibiotics; in Sweden 91 vs 9%, Norway 53 vs 47%, and Denmark 18 vs 82%. In Denmark, almost all patients were operated on immediately, whereas in the other three countries, especially Sweden, operations more often were performed after a recovery period. Combining metronidazole with penicillin or cephalosporins was most common in Denmark: 58% reported usage, compared with 30% in Finland, 16% in Norway, and 4% in Sweden.

Hospital discharge survey on 4,199 peritonsillar abscesses in the Veneto region: what is the risk of recurrence and complications without tonsillectomy?

“…On the other hand, some authors have recommended needle aspiration rather than abscess incision and drainage, as sufficient and cost-effective treatment measures, while others observed that incision and drainage may overcome pain faster than aspiration [10,12,27,28]. Therefore, conclusions are still controversial.…”

“…Moreover, there are several host factor that may promote PTA, such as periodontal disease, smoking, compromised immunity and previous antibiotic use [8,9]. Treatment typically consists of antibiotics, with needle aspiration or drainage of the abscess, steroids, analgesia and fluid resuscitation [10]. Adequate, prompt treatment is mandatory because PTA can give rise, albeit rarely, to lifethreatening complications due to the infection spreading along the deep fascial planes of the neck and chest [11].…”

Cranial tonsillotomy for peritonsillar abscess: what a relief!

“…It is therefore remarkable that despite a lack of evidence abscesstonsillectomy prevails at least in some countries [10,12]. Unfortunately, NA is not documented Return-to-theatre 0 (0 %)…”

“…To date, no commonly accepted guidelines for the treatment of PTA exist and management protocols vary considerably among countries [10], even inside one country in different hospitals [13]. The lack of a gold standard for therapy indicates that there is no ''right'' or ''wrong''.…”

“…Several draining methods have been suggested, including needle aspiration (NA), incision and drainage (ID), or abscesstonsillectomy [2][3][4][5][6][7]. To date, there is no convincing evidence in favor of NA or ID [2,8,9] and management still varies considerably among different nations [10].…”