You Decide: Strep & Throat Abscess
May 20, 2008 by DrReynolds
If you discuss Strep throat long enough someone will eventually bring up the potential complication of a throat abscess. The fancy medical name for this is peritonsillar abscess (or in the U.K. – Quincy). Basically this is when you have a large collection of pus in one of your tonsils. In the era of ready access to the ER, surgeons, and antibiotics this is generally not a serious condition. Left untreated though it can cause some serious problems. While no one would argue that a throat abscess should not be treated, the real question is this:
Should we treat Strep throat in an attempt to prevent a throat abscess?
The Basics
What exactly is a throat abscess?
The reasoning goes that if you have the Strep bacteria in your mouth it can get inside your tonsils and cause an infection. When you get an infection in your tonsils they will swell and may develop into abscess.
An abscess is a collection of pus or infected fluid. Kids commonly get abscesses on their skin, which most people call a boil. An even more common type of abscess is a zit (which is a tiny abscess on the face).
As you can see from the picture above the tonsils are on both sides of the back of the mouth. The picture below shows the general progression – first you get mild swelling of the tonsil and in some cases an abscess may form.
The major problem with a throat abscess is that it must be drained. In adults this is no big deal because you just have to open your mouth and the ER doc or ENT surgeon makes a tiny little cut in your tonsil and the pus drains out. You take a week of antibiotics and you are cured.
While it is generally no more serious than that in kids, it is much harder to get a 5-year old to cooperate with that kind of procedure. Thus in most cases we end up having to send the patient to the OR.
Of course we would like to avoid this if at all possible. So if taking a 10 day course of antibiotics at the first sign of strep will prevent a peritonsillar abscess, then it makes sense to do it. Right?
Tonsillitis and Phayngitis
Do Antibiotics Prevent Throat Abscess
Yes and No?
It really depends on whether you have pharyngitis or tonsillitis. Pharyngitis is the fancy medical word for inflammation and redness in the back of the throat. Pharyngitis is generally painful making it difficult to swallow. By far the most common cause of pharyngitis is the common cold with its associated fever, runny nose, and cough.
Tonsillitis, on the other hand, is swelling and redness of the tonsils, often with pus on the tonsils. This is also very painful making it difficult to swallow. While many things can cause pharyngitis, there are only a handful of things that cause tonsillitis – Strep and Mono are by far the two most common.
Does it really make a difference?
Of course it does…
There is an excellent study that decided to look into the idea that treating Strep throat would prevent the development of a Throat abscess. What they found is not surprising:
- For those kids who have only phayngitis, treating them with antibiotics does not seem to be of any real benefit in preventing a throat abscess. This is probably because a throat abscess is virtually unheard of in kids with only pharyngitis and most cases of pharyngitis are cause by the common cold (a virus).
- On the other hand, there did seem to be some benefit to treating kids who have tonsillitis with antibiotics. The average kid with tonsillitis has somewhere between a 1 in 30 to 1 in 200 chance of developing a throat abscess if they are not treated with antibiotics. Taking penicillin reduces this risk by about 40%.
My Opinion
Based on this study, one could make a logical argument in favor of testing and treating kids for Strep throat if they have tonsillitis. If, on the other hand, there is no swelling, redness, or pus on the tonsils, it does not make a lot of sense to test for Strep throat from the standpoint of preventing a throat abscess since antibiotic treatment does not appear to offer any real benefit.
Of course that is just my opinion. For you and your family… You Decide.
Very interesting, indeed, Dr. Jason! Thanks so much for all the great info you put out here every week – and the very grody pictures of pus on the tonsils – cool! Really, the pictures and diagrams are very helpful.
[...] Acute Rheumatic Fever is just part of the story. While I am making a case that treating every case of Strep throat to prevent ARF may not be the best medical practice, there are some reasons why you might consider treatment. In some situations you might consider treating Strep throat to prevent a throat abscess. [...]