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Introduction <p>Peritonsillar abscess is the most frequent complication of acute tonsillitis. Although adult epidemiology and microbiology are well characterized, age-specific pediatric data remain limited. We investigated the incidence, microbiology, and suitability of penicillin monotherapy for pediatric peritonsillar abscess.</p> Methods <p>We conducted a retrospective cohort study of patients aged 0–17 years admitted with peritonsillar abscess to Aarhus University Hospital, Denmark (2012–2024). Age-stratified incidence rates were calculated using national population data. Bacterial findings and treatment outcomes were analysed across age groups.</p> Results <p>A total of 395 patients (mean age 13.9 ± 3.5 years) were included; 88% (349/395) had cultures performed, of which 81% (281/349) were positive. <i>Fusobacterium necrophorum</i> and <i>Streptococcus pyogenes</i> predominated, with marked age variation: <i>Streptococcus pyogenes</i> prevailed in children ≤ 11 years (61%), while <i>Fusobacterium necrophorum</i> dominated in adolescents aged 16–17 years (57%) (<i>p</i> &lt; 0.001). Peritonsillar abscess incidence increased steadily with age, peaking at 78.4/100,000 in the oldest group. Most patients were treated with penicillin, either intravenously (158/395, 40%) or orally (130/395, 33%). Twelve patients (3%) received broader-spectrum antibiotics, and 95 (24%) patients underwent acute tonsillectomy without antibiotic treatment. Complications were rare (3/395, 1%), all of which involved postoperative pneumonia following tonsillectomy.</p> Conclusion <p>Peritonsillar abscess incidence increases with age, accompanied by a microbiological shift from <i>Streptococcus pyogenes</i> in younger children to <i>Fusobacterium necrophorum</i> among adolescents. Given the high susceptibility of both pathogens to penicillin and the low complication rate, penicillin monotherapy appears to be a safe and adequate empirical treatment across all pediatric age groups.</p> Key points <p>Peritonsillar abscess incidence in children increases with age, with Streptococcus pyogenes predominating in young children and Fusobacterium necrophorum in adolescents. Penicillin monotherapy yielded excellent outcomes, supporting stewardship-conscious empiric therapy tailored to pediatric patients.</p>

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Peritonsillar abscess in children: age-stratified incidence rates, microbiology, and evaluation of penicillin as drug of choice

  • 期刊论文

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  • 发表日期：

    2026年1月3日

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  • Andrea Lund,
  • Pelle Hanberg,
  • Tejs Ehlers Klug

摘要

Introduction

Peritonsillar abscess is the most frequent complication of acute tonsillitis. Although adult epidemiology and microbiology are well characterized, age-specific pediatric data remain limited. We investigated the incidence, microbiology, and suitability of penicillin monotherapy for pediatric peritonsillar abscess.

Methods

We conducted a retrospective cohort study of patients aged 0–17 years admitted with peritonsillar abscess to Aarhus University Hospital, Denmark (2012–2024). Age-stratified incidence rates were calculated using national population data. Bacterial findings and treatment outcomes were analysed across age groups.

Results

A total of 395 patients (mean age 13.9 ± 3.5 years) were included; 88% (349/395) had cultures performed, of which 81% (281/349) were positive. Fusobacterium necrophorum and Streptococcus pyogenes predominated, with marked age variation: Streptococcus pyogenes prevailed in children ≤ 11 years (61%), while Fusobacterium necrophorum dominated in adolescents aged 16–17 years (57%) (p < 0.001). Peritonsillar abscess incidence increased steadily with age, peaking at 78.4/100,000 in the oldest group. Most patients were treated with penicillin, either intravenously (158/395, 40%) or orally (130/395, 33%). Twelve patients (3%) received broader-spectrum antibiotics, and 95 (24%) patients underwent acute tonsillectomy without antibiotic treatment. Complications were rare (3/395, 1%), all of which involved postoperative pneumonia following tonsillectomy.

Conclusion

Peritonsillar abscess incidence increases with age, accompanied by a microbiological shift from Streptococcus pyogenes in younger children to Fusobacterium necrophorum among adolescents. Given the high susceptibility of both pathogens to penicillin and the low complication rate, penicillin monotherapy appears to be a safe and adequate empirical treatment across all pediatric age groups.

Key points

Peritonsillar abscess incidence in children increases with age, with Streptococcus pyogenes predominating in young children and Fusobacterium necrophorum in adolescents. Penicillin monotherapy yielded excellent outcomes, supporting stewardship-conscious empiric therapy tailored to pediatric patients.