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For further information, see CMDT Part 8-21: Peritonsillar Abscess & Cellulitis

Key Features

  • Results when infection penetrates the tonsillar capsule and involves the surrounding tissues

  • Following therapy, peritonsillar cellulitis usually either resolves over several days or evolves into peritonsillar abscess

Clinical Findings

  • Peritonsillar abscess (quinsy) and cellulitis present with

    • Severe sore throat

    • Odynophagia

    • Trismus

    • Medial deviation of the soft palate and peritonsillar fold

    • Abnormal muffled ("hot potato") voice


  • Abscess may be confirmed by aspirating pus from the peritonsillar fold just superior and medial to the upper pole of the tonsil

  • A 19-gauge or 21-gauge needle should be passed medial to the molar and no deeper than 1 cm, because the internal carotid artery may lie more medially than its usual location and pass posterior and deep to the tonsillar fossa


  • Most commonly, patients present to the emergency department and receive a dose of parenteral amoxicillin (1 g), amoxicillin-sulbactam (3 g), or clindamycin (600–900 mg)

  • Less severe cases and patients who are able to tolerate oral intake may be treated for 7–10 days with oral antibiotics, including

    • Amoxicillin, 500 mg three times a day

    • Amoxicillin-clavulanate, 875 mg twice a day

    • Clindamycin, 300 mg four times daily

  • Methods for surgical management include needle aspiration, incision and drainage, and tonsillectomy

    • The data are largely equivocal for all three approaches

    • Some clinicians incise and drain the area and continue with parenteral antibiotics, whereas others aspirate only and monitor as an outpatient

    • In acutely infected patients with more severe or recurrent peritonsillar abscesses, it may be appropriate to consider immediate tonsillectomy (quinsy tonsillectomy), although clinicians have moved away from this approach due to the potential for complications

  • Recurrent or atypical peritonsillar abscesses in older adults should be evaluated for an underlying head and neck malignancy

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