A review of the pathogenesis of adult peritonsillar abscess: time for a re-evaluation

J Antimicrob Chemother. 2013 Sep;68(9):1941-50. doi: 10.1093/jac/dkt128. Epub 2013 Apr 23.


Objectives: To perform a multifactorial exploration of the aetiology of peritonsillar abscess (PTA) in adults, in order to develop greater clinical understanding of the condition and improve management.

Design: A literature review exploring key pathogens, predisposing host factors and current pathogenic hypotheses.

Methods: A PubMed search for articles published between January 1980 and January 2012 using the terms 'peritonsillar abscess AND microbiology', 'peritonsillar abscess AND pathophysiology' and 'peritonsillar abscess AND etiology'.

Results: Major pathogens in PTA are opportunistic microflora. Group A streptococcal PTA infections present differently from polymicrobial PTA. A number of host factors influence the conditions required for the pathogenesis of PTA.

Conclusions: PTA is clinically distinct from acute tonsillitis and occurs in people with a chronic underlying susceptibility. Targeting host factors, including oral hygiene, antibiotic use and smoking, may prevent PTA. Re-education of clinicians concerning the aetiology of PTA is necessary for appropriate disease management.

Keywords: aetiology; microbiology; quinsy.

Publication types

  • Review

MeSH terms

  • Disease Susceptibility
  • Humans
  • Opportunistic Infections / etiology*
  • Opportunistic Infections / physiopathology*
  • Peritonsillar Abscess / etiology*
  • Peritonsillar Abscess / physiopathology*
  • Peritonsillar Abscess / therapy