TOPLINE:

Conservative antibiotic therapy was identified as a safe and effective approach for treating selected children diagnosed with peritonsillar abscess; most children responded to antibiotics alone, but older children and those presenting with severe symptoms might have required closer monitoring.

METHODOLOGY:

• Researchers conducted a retrospective study to evaluate the efficacy and safety of conservative antibiotic treatment in children diagnosed with peritonsillar abscess between January 2004 and December 2014.
• They included 107 children, identified through electronic medical records, and categorized them into two groups: those managed conservatively with antibiotics (n = 93; median age, 12.5 years; 59% girls) and those who underwent first-line surgery (n = 14; median age, 13.2 years; 43% girls).
• Conservative treatment involved administering intravenous amoxicillin-clavulanate, which was switched to oral antibiotics once the patient improved.
• The primary outcome was primary treatment failure, defined as the need for surgery or development of complications within 2 weeks of initiating conservative treatment.
• Secondary outcomes included secondary failure — recurrence or complications of peritonsillar abscess occurring more than 2 weeks after the start of conservative treatment — and overall failure, which comprised both primary and secondary failures.

TAKEAWAY:

• Among children managed conservatively, 6.4% experienced primary treatment failure that required surgery, but no complications were reported.
• Children receiving conservative therapy who experienced primary failure were significantly older (median age, 15.6 vs 11.7 years; P = .02) and were more likely to have severe symptoms than those who did not experience primary failure.
• Secondary failure occurred in 9.6% of children receiving conservative therapy, who experienced at least one recurrence of peritonsillar abscess, with some recurrences observed up to 8 years after the initial episode.
• Overall failure occurred in 16.1% of children receiving conservative therapy and significantly affected older children, with an adjusted odds ratio of 1.19 per 1-year increase in age (P = .03).

IN PRACTICE:

“Despite the traditional perception that non-surgical management of PTA [peritonsillar abscess] is not the standard of care, our findings advocate for its safety and efficacy as a viable alternative to surgical intervention,” the authors wrote.

SOURCE:

This study was led by Francesca Hoegger, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland. It was published online on September 18, 2025, in the European Journal of Pediatrics.

LIMITATIONS:

Children in the surgical treatment group were older than those in the conservative treatment group, which may have led to an underestimation of failure rates. Additionally, the small number of failure events, retrospective study design, and lack of standardization in intravenous-to-oral transition and total antibiotic duration further limited the findings.

DISCLOSURES:

Funding for open-access publication of this study was provided by the University of Lausanne, and the authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.