[Management of peritonsillar infections]. / Tratamiento de la infección periamigdalina.

OBJECTIVE: To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. PATIENTS AND METHODS: A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. RESULTS: Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. CONCLUSIONS: The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.

Tratamiento de la infección periamigdalina / Management of peritonsillar infections

Objetivo Analizar las características clínicas y epidemiológicas de niños afectados de infección periamigdalar. Pacientes y métodos Estudio longitudinal y restrospectivo de revisión de historias clínicas en los casos detectados los últimos 6 años atendidos en Urgencias. Se anotaron las variables de edad, sexo, amigdalitis de repetición, catarro previo de vías altas, administración de antibiótico y actitud terapéutica adoptada. Resultados Fueron ingresados 29 niños cuya edad media era de 7,4 +/- 1,6 años (varones 1,6:1). El 27 % cursaba con amigdalitis de repetición y el 57,8 % con catarro en el momento de la consulta, de los que el 65 % llevaba tratamiento antibiótico, especialmente macrólidos. El tratamiento seleccionado en nuestro centro fue la asociación penicilina o amoxicilina-ácido clavulánico con clindamicina, incluyendo corticoides. En 10 niños se practicó estudio de imagen mediante tomografía axial (TC) y en nueve punción-aspiración mediante aguja fina (PAAF). Ante la confirmación de absceso, se efectuó drenaje en el 20,6 % de los casos. La estancia hospitalaria fue de 5,6 +/- 1,6 días. Se practicó amigdalectomía diferida en el 31 %, excepto en un caso que desarrolló un absceso parafaríngeo. La población infantil padece en la actualidad el 18,9 % de todos los casos de infección periamigdalina. Conclusiones Este incremento está probablemente relacionado con el tratamiento inapropiado de antibióticos en enfermedades respiratorias. El diagnóstico es clínico y a menudo la administración intravenosa de betalactámicos con clindamicina y una actitud expectante son resolutivos. La sospecha de absceso o la ausencia de mejoría clínica recomiendan realizar PAAF y/o TC y drenaje ante su confirmación. La amigdalectomía, normalmente diferida, debería indicarse sólo en casos de amigdalitis de repetición

Objective To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. Patients and methods A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. Results Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. Conclusions The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of Beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis