Peritonsillar abscess: Tonsil antibiotic levels in patients treated by acute abscess surgery

Robert H. Maisel

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Abstract

Forty-five patients who had tonsillectomy in the acute phase of peritonsillar abscess were studied. All patients received intravenous penicillin or cephalosporin before surgery. Samples of tonsil from each side were evaluated for penicillin and cephalosporin as was a blood sample obtained during surgery. The tonsil tissue antibiotic levelB were compared between the infected and non-abscess side. We expected to find less antibiotic on the inflamed side since less bleeding from the abscessed tonsil bed usually suggests less blood flow through this tonsil, and we also expected a low, satisfactory tissue level in patients under usual regimens of intravenous antibiotics. Our results indicate that 60% of the patients had evidence of streptococcal infections by culture or serum assay. All patients completed the treatment without complications. Eighty-five percent of abscesses were in the superior pole and 15% were located posteriorly and would be adequately drained only by tonsillectomy. There was no clear seasonal peak to the infection and no evidence of specific virulence of the streptococci found. Tissue antibiotic assay showed only 32% of the patients on penicillin had a measurable tissue level and 66% of the cephalosporin treated patients had detectable antibiotic levels in the tissue. The abscessed tonsil was equally as likely to have increased levels of penicillin as its uninflamed mate while in all cases, where detectable, the abscessed tonsil had increased concentrations of cephalosporin relative to the opposite side. We conclude that penicillin does not penetrate tonsil tissue very well and does not favor either the infected or uninfected side while the cephalosporins may have a specific reduced tissue barrier to penetration in the presence of inflammation. Therefore, we recommend medical treatment with 1 gm of penicillin intravenously every 4 hours or 1 gm of cephalosporin every 6 to 8 hours intravenously with an additional dose of the intravenous antibiotic at the time of tonsillectomy.

Original languageEnglish (US)
Pages (from-to)80-87
Number of pages8
JournalLaryngoscope
Volume92
Issue number1
StatePublished - Jan 1982

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