A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses

Research output: Research - peer-reviewArticle

Abstract

On the basis of strong research evidence (level A), children older than 3 years with sore throat in the absence of viral symptoms should be tested for group A Streptococcus (GAS) pharyngitis. • On the basis of strong research evidence (level A), oral or intramuscular penicillin and amoxicillin are first-line treatments for GAS pharyngitis. • On the basis of research evidence (level B), first-generation cephalosporins, macrolides, or clindamycin are acceptable alternatives for penicillin-allergic patients. • On the basis of research evidence (level B), asymptomatic carriers of GAS should not be treated with antibiotic therapy. • On the basis of limited evidence (level C), diagnosis of peritonsillar abscesses can usually be made based on clinical suspicion and laboratory testing/imaging are often unnecessary. • On the basis of research evidence (level C), imaging for retropharyngeal abscess should be reserved only when the diagnosis is in question, when operative management is required, or when there is lack of improvement after 48 to 72 hours of intravenous antibiotic therapy. On the basis of expert opinion (level D), decision to proceed with tonsillectomy and adenoidectomy (T&A) should be made jointly between the physician and patient family after counseling them about the risks, benefits, and consideration of individual preferences. Cases that do not meet the criteria for T&A (severe recurrent throat infections, moderate throat infection with modifying factors, sleepdisordered breathing with comorbid conditions and/or abnormal polysomnography) should be managed by watchful waiting.

LanguageEnglish (US)
Pages81-92
Number of pages12
JournalPediatrics in Review
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Retropharyngeal Abscess
Peritonsillar Abscess
Tonsillitis
Hypertrophy
Research
Pharyngitis
Streptococcus
Therapeutics
Pharynx
Penicillins
Anti-Bacterial Agents
Infection
Watchful Waiting
Adenoidectomy
Tonsillectomy
Clindamycin
Polysomnography
Amoxicillin
Macrolides
Family Physicians

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{48dfe933df574ed5b30f71ab9a8f27c4,
title = "A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses",
abstract = "On the basis of strong research evidence (level A), children older than 3 years with sore throat in the absence of viral symptoms should be tested for group A Streptococcus (GAS) pharyngitis. • On the basis of strong research evidence (level A), oral or intramuscular penicillin and amoxicillin are first-line treatments for GAS pharyngitis. • On the basis of research evidence (level B), first-generation cephalosporins, macrolides, or clindamycin are acceptable alternatives for penicillin-allergic patients. • On the basis of research evidence (level B), asymptomatic carriers of GAS should not be treated with antibiotic therapy. • On the basis of limited evidence (level C), diagnosis of peritonsillar abscesses can usually be made based on clinical suspicion and laboratory testing/imaging are often unnecessary. • On the basis of research evidence (level C), imaging for retropharyngeal abscess should be reserved only when the diagnosis is in question, when operative management is required, or when there is lack of improvement after 48 to 72 hours of intravenous antibiotic therapy. On the basis of expert opinion (level D), decision to proceed with tonsillectomy and adenoidectomy (T&A) should be made jointly between the physician and patient family after counseling them about the risks, benefits, and consideration of individual preferences. Cases that do not meet the criteria for T&A (severe recurrent throat infections, moderate throat infection with modifying factors, sleepdisordered breathing with comorbid conditions and/or abnormal polysomnography) should be managed by watchful waiting.",
author = "Bochner, {Risa E.} and Mona Gangar and Belamarich, {Peter F.}",
year = "2017",
month = "2",
doi = "10.1542/pir.2016-0072",
volume = "38",
pages = "81--92",
journal = "Pediatrics in Review",
issn = "0191-9601",
publisher = "American Academy of Pediatrics",
number = "2",

}

TY - JOUR

T1 - A clinical approach to tonsillitis, tonsillar hypertrophy, and peritonsillar and retropharyngeal abscesses

AU - Bochner,Risa E.

AU - Gangar,Mona

AU - Belamarich,Peter F.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - On the basis of strong research evidence (level A), children older than 3 years with sore throat in the absence of viral symptoms should be tested for group A Streptococcus (GAS) pharyngitis. • On the basis of strong research evidence (level A), oral or intramuscular penicillin and amoxicillin are first-line treatments for GAS pharyngitis. • On the basis of research evidence (level B), first-generation cephalosporins, macrolides, or clindamycin are acceptable alternatives for penicillin-allergic patients. • On the basis of research evidence (level B), asymptomatic carriers of GAS should not be treated with antibiotic therapy. • On the basis of limited evidence (level C), diagnosis of peritonsillar abscesses can usually be made based on clinical suspicion and laboratory testing/imaging are often unnecessary. • On the basis of research evidence (level C), imaging for retropharyngeal abscess should be reserved only when the diagnosis is in question, when operative management is required, or when there is lack of improvement after 48 to 72 hours of intravenous antibiotic therapy. On the basis of expert opinion (level D), decision to proceed with tonsillectomy and adenoidectomy (T&A) should be made jointly between the physician and patient family after counseling them about the risks, benefits, and consideration of individual preferences. Cases that do not meet the criteria for T&A (severe recurrent throat infections, moderate throat infection with modifying factors, sleepdisordered breathing with comorbid conditions and/or abnormal polysomnography) should be managed by watchful waiting.

AB - On the basis of strong research evidence (level A), children older than 3 years with sore throat in the absence of viral symptoms should be tested for group A Streptococcus (GAS) pharyngitis. • On the basis of strong research evidence (level A), oral or intramuscular penicillin and amoxicillin are first-line treatments for GAS pharyngitis. • On the basis of research evidence (level B), first-generation cephalosporins, macrolides, or clindamycin are acceptable alternatives for penicillin-allergic patients. • On the basis of research evidence (level B), asymptomatic carriers of GAS should not be treated with antibiotic therapy. • On the basis of limited evidence (level C), diagnosis of peritonsillar abscesses can usually be made based on clinical suspicion and laboratory testing/imaging are often unnecessary. • On the basis of research evidence (level C), imaging for retropharyngeal abscess should be reserved only when the diagnosis is in question, when operative management is required, or when there is lack of improvement after 48 to 72 hours of intravenous antibiotic therapy. On the basis of expert opinion (level D), decision to proceed with tonsillectomy and adenoidectomy (T&A) should be made jointly between the physician and patient family after counseling them about the risks, benefits, and consideration of individual preferences. Cases that do not meet the criteria for T&A (severe recurrent throat infections, moderate throat infection with modifying factors, sleepdisordered breathing with comorbid conditions and/or abnormal polysomnography) should be managed by watchful waiting.

UR - http://www.scopus.com/inward/record.url?scp=85014700466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014700466&partnerID=8YFLogxK

U2 - 10.1542/pir.2016-0072

DO - 10.1542/pir.2016-0072

M3 - Article

VL - 38

SP - 81

EP - 92

JO - Pediatrics in Review

T2 - Pediatrics in Review

JF - Pediatrics in Review

SN - 0191-9601

IS - 2

ER -