Peritonsillar cellulitis (abscess): Oral antibiotic regimens

Antibiotic	Adults	Children and infants >28 days	Duration^*
S. aureus susceptible
Amoxicillin-clavulanate	875 mg/125 mg twice daily	7:1 formulation (amoxicillin component 200 mg per 5 mL): 22.5 mg/kg (amoxicillin component) twice daily (maximum 875 mg amoxicillin and 125 mg clavulanate per dose) or 4:1 formulation (amoxicillin component 125 or 250 mg per 5 mL): 10 mg/kg (amoxicillin component) 3 times daily (maximum 500 mg amoxicillin and 125 mg clavulanate per dose) or 14:1 formulation (amoxicillin component 600 mg per 5 mL): 19 mg/kg (amoxicillin component) twice daily (maximum 875 mg amoxicillin and 64 mg clavulanate per dose)^¶	14 days
Presumed MRSA^Δ
Linezolid	600 mg twice daily	12 years: 10 mg/kg 3 times daily (maximum total daily dose 1200 mg) ≥12 years: 600 mg twice daily	14 days
or
Clindamycin^◊	300 to 450 mg 3 times daily	10 mg/kg 3 times daily (maximum 450 mg per dose)

This table provides empiric antibiotic regimens for patients with peritonsillar cellulitis or continuation regimens for patients with peritonsillar abscess who have improved on parenteral therapy. The doses provided are intended for patients with normal kidney and liver function; refer to drug information monographs for dose adjustments. Antibiotic regimens should be tailored to culture and susceptibility data (if drainage is performed) or based upon clinical response to treatment. When tailoring therapy based upon culture results, it is important to understand that peritonsillar abscesses are frequently polymicrobial, and not all microbes are consistently cultured.

MRSA: methicillin-resistant Staphylococcus aureus.

* For patients with peritonsillar cellulitis, the duration of oral therapy is 14 days. For patients with peritonsillar abscess, oral therapy is given to complete a total of 14 days of antibiotics once parenteral therapy has resulted in defervescence and clinical improvement.

¶ The 14:1 formulation maximizes the amoxicillin component and minimizes the risk of diarrhea. For larger children, many experts round off this maximum dose to 900 mg (volume 7.5 mL) for caregiver convenience with measuring and administration given minimal to no risk for this dose.

Δ When vancomycin has been added to the parenteral regimen, oral therapy can be based upon susceptibility testing of the isolates, if available.

◊ Oral clindamycin is only used for patients who have responded to parenteral clindamycin or have penicillin allergy. Otherwise, we generally avoid clindamycin, if possible, due to risk for Clostridioides difficile infection and the possibility of streptococcal and staphylococcal resistance (refer to UpToDate content for details).

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Peritonsillar cellulitis (abscess): Oral antibiotic regimens