Peritonsillar Abscess (Quinsy) — Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Airway involvement/deep neck spread?
   Any airway involvement/abscess formation? (The most common deep neck infection in adolescents/young adults, usually following acute tonsillitis, polymicrobial (GABHS most common + oral anaerobes). Several days of severe unilateral sore throat + odynophagia + ipsilateral ear pain + fever, trismus (the hallmark, ~2/3, distinguishing it from simple tonsillitis), 'hot potato' voice, drooling, halitosis; exam shows the tonsil displaced inferomedially, soft palate bulging + uvula deviated to the opposite side. Diagnosis: clinical ± ultrasound/contrast CT (define extent, exclude deep neck infection).)
   • Airway involvement/sepsis/deep neck spread → Airway/deep neck → admit
   • Stable, localized abscess → Stable · drainage + antibiotics
2. [End] Stable · drainage + antibiotics
   Stable, localized abscess: drainage (needle aspiration/incision and drainage/abscess tonsillectomy — similar efficacy) + antibiotics (cover GABHS + oral anaerobes: amoxicillin-clavulanate/ampicillin-sulbactam or clindamycin ± metronidazole) + a single dose of steroid to reduce pain and trismus + hydration and analgesia; usually outpatient with ENT follow-up at 24–36 h; <3–5 days is often cellulitis/pre-abscess and may be treated with antibiotics first.
3. [End] Airway/deep neck → admit
   Airway involvement (drooling/stridor/dyspnea)/sepsis/deep neck or parapharyngeal spread/unable to eat: admit — protect the airway (ENT/anesthesia present if needed), IV antibiotics + steroid + hydration, imaging to assess deep neck extent, surgical drainage; beware Lemierre's, carotid involvement, hemorrhage.

Source guidelines & references

• Peritonsillar abscess (AAFP; StatPearls)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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