ArticleAnnals of clinical microbiology and antimicrobials2026
Peritonsillar abscess in children: age-stratified incidence rates, microbiology, and evaluation of penicillin as drug of choice.
Article in Annals of clinical microbiology and antimicrobials, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionPeritonsillar 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.
methodsWe 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.
resultsA 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.
conclusionPeritonsillar 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.
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