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Peritonsillar cellulitis (abscess): Oral antibiotic regimens

Peritonsillar cellulitis (abscess): Oral antibiotic regimens
Antibiotic Adult dosing Pediatric dosing
(children and infants >28 days)		 Duration*
S. aureus susceptible
Amoxicillin-clavulanate

Amoxicillin 1000 mg/clavulanate 62.5 mg extended-release tablet: One tablet twice daily

or

Amoxicillin 875 mg /clavulanate 125 mg tablet: One tablet twice daily

High doseΔ: 45 mg/kg per dose (amoxicillin component) twice daily (maximum total daily amoxicillin dose: 2000 mg)

Weight <40 kg:

  • Amoxicillin 600 mg/clavulanate 42.9 mg per 5 mL suspension (14:1 formulation): 45 mg/kg amoxicillin per dose (maximum of 1000 mg amoxicillin per dose) twice daily

Weight ≥40 kg:

  • Amoxicillin 1000 mg/clavulanate 62.5 mg extended-release tablet (16:1 formulation): One tablet twice daily
  • or
  • Amoxicillin 875 mg/clavulanate 125 mg tablet (7:1 formulation): One tablet twice daily
  • or
  • Amoxicillin 400 mg/clavulanate 57 mg per 5 mL suspension (7:1 formulation): 1000 mg amoxicillin per dose twice daily
 14 days
Presumed MRSA◊
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.

¶ Alternative for children and adolescents ≥40 kg who prefer a tablet formulation and adults when the amoxicillin 1000 mg/clavulanate 62.5 mg extended-release tablet (16:1 formulation) is not available.

Δ Evidence is limited regarding the optimal dosing strategy for amoxicillin-clavulanate in children. Some experts use standard dosing of amoxicillin-clavulanate (45 mg/kg of amoxicillin per day) to treat all patients with peritonsillar cellulitis or abscess. For specific formulations and general dosing guidance for standard dose regimens, refer to the amoxicillin-clavulanate drug information included within UpToDate. Our approach is to use high dose in most patients, especially those with peritonsillar cellulitis to increase tissue penetration and to avoid the development of an abscess.

◊ 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).

Graphic 145296 Version 5.0

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