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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.

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