If admitted to observation unit: antibiotics will be IV Clindamycin mg q6 hours; if allergic, IV Vancomycin 1 g q12 hours should be given. Once discharged, they will receive the same prescription as the discharged group of subjects. In addition to the standard of care described and any additional medications deemed appropriate by the attending physician that do not represent a confounding factor to the study NSAIDs, other antibiotics , subjects will also receive an additional pill which will be either prednisone 60 mg or placebo.
If the treating physician feels it is in the best interest of the subject to break the protocol, the subject's participation in study procedures will end. Data that has already been collected will be kept, and may be analyzed separately. Once the subjects have received the study medications, they will follow their dispositions either be discharged or be admitted in the observation's unit.
To assure treatment compliance, the Research Associate will provide the subjects with antibiotics and pain medication treatment corresponding to the first 48 hours. After this landmark, the subjects will cover the rest of their treatment. Subjects will be instructed not to take any medication outside the prescription during the length of the study. If the subjects take NSAIDs during the first 48 hours, this could be considered a confounding factor.
As such, subjects who take NSAIDs within the first 48 hours will have their participation in study procedures ended. Their already collected data will be kept and may be analyzed separately; however, if they take NSAIDs after the hour visit their study participation will continue. Subjects will be required to return to the ED after 48 hours and bring the remaining prescribed pain medications. They will meet a Research Associate for re-evaluation, which will be done by using a VAS, measuring the cellulitic area, and assessing the degree of usage of the prescribed pain medications.
This second visit is not part of the standard of care so patients won't be required to receive a formal evaluation by an ED doctor nor register in triage. Financial compensation will be provided on completion of the 48 hour follow-up visit for all patients. Drug: Prednisone See "Prednisone" arm description Other Names: Deltasone Prednicot Sterapred Placebo Comparator: Placebo In addition to standard care for cellulitis, subjects will receive a single placebo pill to take during their initial visit.
Secondary Outcome Measures : Amount of Pain Medication - Day 1 to 48 Hours [ Time Frame: Assessed once during the 48 hour follow-up ] Number of times the subject needed to use pain medication between day 1 and the 48 hour follow-up Amount of Pain Medication - Day 1 to 7 Days [ Time Frame: Assessed once during the 7 day follow-up ] Total amount of pain medication used between day 1 and the 7 day follow-up call. Amount of Pain Medication - 48 Hours to 7 Days [ Time Frame: Assessed at the 48 hour follow-up and at the 7 day follow-up ] Amount of pain medication the subject needed to use between the 48 hour follow-up and the 7 day follow-up.
Number of Participants Requiring Additional Medical Assistance Post-Randomization [ Time Frame: Assessed continuously from day 1 to the day 7 follow-up call ] Need for additional medical intervention to treat the current episode of cellulitis. Disposition Trend [ Time Frame: Assessed once during day 1 ] Disposition of the subject at the end of the initial visit on day 1; "Disposition Trend" refers to whether the subject was discharged to home or admitted to observation unit in the hospital.
This Outcome Measure intends to assess improvement from baseline following intervention. Higher values represent worse outcome. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies. If subject is going to the Observation unit, allergy to:.
Suspicion or presence of severe sepsis, as defined by:. Hide glossary Glossary Study record managers: refer to the Data Element Definitions if submitting registration or results information. Search for terms. Save this study. Warning You have reached the maximum number of saved studies Use of a Single Dose of Oral Prednisone in the Treatment of Cellulitis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
Listing a study does not mean it has been evaluated by the U. Federal Government. Read our disclaimer for details. Results First Posted : February 10, Last Update Posted : February 10, Study Description. Cellulitis is the medical term for an infection of the skin, with symptoms including redness, swelling, warmth, and pain.
This group of symptoms is called inflammation, and is caused by the body's immune system responding to the infection. Standard care for cellulitis is using antibiotics to destroy the infection, but the inflammation can persist and cause a great deal of pain. The hypothesis of this study is that adding a single dose of an oral steroid prednisone , which tempers the immune response, will reduce inflammation, reduce pain, and speed recovery.
This hypothesis will be examined by recruiting a group of patients with cellulitis, and randomizing them to two sub-groups: one group will receive a dose of prednisone, while the other group will receive a placebo. Neither group will know what they received unless there is a problem. These subjects will be followed up at the 48 hour mark and the 7 day mark, and will have their results compared.
Show detailed description. Hide detailed description. Detailed Description:. Drug Information available for: Prednisone. FDA Resources. To avoid potential serious complications, prompt recognition and initiation of therapy is important. Family physicians with appropriate training and experience can diagnose and treat most patients with peritonsillar abscess. Peritonsillar abscess is the most common deep infection of the head and neck in young adults, despite the widespread use of antibiotics for treating tonsillitis and pharyngitis.
This infection can occur in all age groups, but the highest incidence is in adults 20 to 40 years of age. Prompt recognition and initiation of therapy is important to avoid potential serious complications. Treatment for peritonsillar abscess should include drainage and antibiotic therapy.
Initial empiric antibiotic therapy for peritonsillar abscess should include antimicrobials effective against Group A streptococcus and oral anaerobes. Steroids may be useful in reducing symptoms and in speeding recovery in patients with peritonsillar abscess. The two palatine tonsils lie on the lateral walls of the oropharynx in the depression between the anterior tonsillar pillar palatoglossal arch and the posterior tonsillar pillar palatopharyngeal arch.
The tonsils form during the last months of gestation and grow irregularly, reaching their largest size at approximately six or seven years of age. The tonsils begin to gradually involute at puberty, and by older age little tonsillar tissue remains. Peritonsillar abscesses form in the area between the palatine tonsil and its capsule.
Peritonsillar abscess has traditionally been regarded as the end point of a continuum that begins as acute exudative tonsillitis, progresses to cellulitis, and eventually forms an abscess. A recent review implicates Weber's glands as playing a key role in the formation of peritonsillar abscesses. If Weber's glands become inflamed, local cellulitis can develop. As the infection progresses, the duct to the surface of the tonsil becomes progressively more obstructed from surrounding inflammation.
The resulting tissue necrosis and pus formation produce the classic signs and symptoms of peritonsillar abscess. Other clinical variables include significant periodontal disease and smoking. Patients with peritonsillar abscess appear ill and present with fever, malaise, sore throat, dysphagia, or otalgia.
The throat pain is markedly more severe on the affected side and is often referred to the ear on the same side. Physical examination usually reveals trismus, with the patient having difficulty opening his or her mouth because of pain from inflammation and spasm of masticator muscles. Markedly tender cervical lymphadenitis may be palpated on the affected side. Inspection of the oropharynx reveals tense swelling and erythema of the anterior tonsillar pillar and the soft palate overlying the infected tonsil.
The tonsil is generally displaced inferiorly and medially with contralateral deviation of the uvula Figure 1. The most common symptoms and physical findings are summarized in Table 1. Potential complications of peritonsillar abscess are outlined in Table 2. Death can occur from airway obstruction, aspiration, or hemorrhage from erosion or septic necrosis into the carotid sheath.
Erythematous, swollen soft palate with uvula deviation to contralateral side and enlarged tonsil. Aspiration pneumonitis or lung abscess secondary to peritonsillar abscess rupture. Death secondary to hemorrhage from erosion or septic necrosis into carotid sheath. Extension of the infection into the tissues of the deep neck or posterior mediastinum. Poststreptococcal sequelae e.
The diagnosis of peritonsillar abscess is often made on the basis of a thorough history and physical examination. Differential diagnosis includes infectious mononucleosis, lymphoma, peritonsillar cellulitis, and retromolar or retropharyngeal abscess.
Patients often present with peritonsillar cellulitis with the potential to progress to abscess formation. In peritonsillar cellulitis, the area between the tonsil and its capsule is edematous and erythematous, but pus has not yet formed. On occasions when the diagnosis of peritonsillar abscess is in question, the presence of pus on needle aspiration or radiologic testing may help confirm the diagnosis.
Transcutaneous or intraoral ultrasonography also can be helpful in identifying an abscess and in distinguishing peritonsillar abscess from peritonsillar cellulitis. CT can distinguish between peritonsillar cellulitis and peritonsillar abscess, as well as demonstrate the spread of the infection to any contiguous spaces in the deep neck region Figure 2. MRI has the advantage of improved soft-tissue definition over CT without exposure to radiation.
Additionally, MRI is superior to CT in detecting complications from deep neck infections such as internal jugular vein thrombosis or erosion of the abscess into the carotid sheath. Disadvantages of MRI include longer scanning times, higher cost, lack of availability, and the potential for claustrophobia. Drainage of the abscess, antibiotics, and supportive therapy to maintain hydration and pain control are the foundation of treatment for peritonsillar abscess.
Because peritonsillar cellulitis represents a transitional stage in the development of peritonsillar abscess, its treatment is similar to that of a peritonsillar abscess, excluding the need for surgical drainage. The main procedures for the drainage of peritonsillar abscess are needle aspiration, incision and drainage, and immediate tonsillectomy.
Drainage using any of these methods combined with antibiotic therapy will result in resolution of the peritonsillar abscess in more than 90 percent of cases. Although it is not routinely performed for the treatment of peritonsillar abscess, immediate tonsillectomy should be considered for patients who have strong indications for tonsillectomy, including those who have symptoms of sleep apnea, a history of recurrent tonsillitis four or more infections per year despite adequate medical therapy , or a recurrent or nonresolving peritonsillar abscess.
Several other studies have reported that more than 50 percent of culture results demonstrated the presence of betalactamase producing anaerobes, leading many physicians to use broader-spectrum antibiotics as first-line therapy. Information from references 8 and Penicillin G 10 million units every six hours plus metronidazole Flagyl mg every six hours. Penicillin VK mg four times daily plus metronidazole mg four times daily. Information from reference Although steroids have been used to treat edema and inflammation in other otolaryngologic diseases, their role in the treatment of peritonsillar abscess has not been extensively studied.
A recent study reported that 32 patients who received a single high dose of steroids methylprednisolone [DepoMedrol] 2 to 3 mg per kg up to mg intravenously plus antibiotics responded much more quickly to treatment than 28 patients who received antibiotics plus placebo.
When the family physician is inexperienced in treating peritonsillar abscess or when complications or questions arise during treatment, an otolaryngologist should be consulted. Once the diagnosis has been established, drainage or aspiration of the abscess should be performed in a setting where possible airway complications can be managed.
The patient should be observed for a few hours after aspiration to ensure he or she can tolerate oral antibiotics and pain medications. Outpatient follow-up should occur in 24 to 36 hours. Most patients with a peritonsillar abscess can be treated in an outpatient setting, but a small percentage e. The overall risk of developing a second peritonsillar abscess is approximately 10 to 15 percent. Already a member or subscriber? Log in. Galioto received his medical degree from Creighton University in Omaha, Neb.
Address correspondence to Nicholas J. Reprints are not available from the author. Steyer TE. Peritonsillar abscess: diagnosis and treatment [Published correction appears in Am Fam Physician. Am Fam Physician. Khayr W, Taepke J. Management of peritonsillar abscess: needle aspiration versus incision and drainage versus tonsillectomy.
Am J Ther. Belleza WG, Kalman S. Otolaryngologic emergencies in the outpatient setting. Med Clin North Am. Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. Clin Infect Dis. Berkovitz BK, ed. In: Standring S, ed.
Impaction of the anal sacs occurs when the anal gland secretions contained in the anal sac thicken so that the sac is unable to empty during a bowel movement. Inflammation of the anal sac, or anal sacculitis, is an infection usually resulting from impaction; it may also be caused by bacterial growth within the anal sac. During the sacculitis stage, the impacted fluid may become thinner and fill with pus.
Abscess occurs when the inflammation of the anal sac has reached an extreme stage; at this point, a red-brown substance will be seen coming from the sac, which will be enlarged, hot, red, and very painful. Usually, the abscessed sac will rupture, leaving a hole near the side of the rectum that oozes a foul-smelling liquid.
The tissues surrounding the abscess will swell up, and this will worsen the dog's inflammation and pain. Diagnosis: Diagnosis and staging of anal sac disease is made clinically with a rectal examination. Impacted or swollen anal sacs are often quite painful and some dogs may need sedation before a thorough examination can be done.
Normal anal sac fluid is clear or pale yellow-brown; thick, brown or yellowish-green secretions are typical of animals with anal sac disease. If the inflammation of the anal sacs has led to an abscess, a large, red, and swollen area may be visible on the side of the anus. A rupture of the abscessed sac can result in the oozing of a foul-smelling liquid material. Prognosis: Expression, or applying pressure to the anal sac, is a successful method for removing impacted secretions from the anal glands, but in many cases, this procedure must be performed on a regular basis to prevent recurrence.
Antibiotics most often eliminate the infection. If abscess has occurred, the abscessed anal sacs usually heal. However, all animals with anal sac disease usually have to have their anal sacs expressed on a regular basis to prevent further problems. Treatment: When the anal sac disease is at the impaction stage, the most common treatment is an outpatient procedure called expression in which the veterinarian applies pressure to the anal glands until the thickened secretions are expelled from the sacs.
Sedation may be needed if the dog is nervous or is in great pain. For the anal sacculitis stage of the disease, the same expression procedure is performed; afterwards, an antibiotic-steroid combination ointment is applied directly to the anal sac. In addition, the examining veterinarian may prescribe oral antibiotics to help fight infection.
To help determine the appropriate antibiotic, the veterinarian may also need to take cultures to identify what type of bacteria caused the sacculitis. When anal sac disease is at the abscess stage, a surgical procedure is required if the abscess has not already ruptured. The veterinarian, after sedating the dog or placing it under general anesthesia, will surgically open the infected anal sac to clean out the infected material and drain the remaining liquid.
Following surgery for ruptured abscesses, an antibiotic-steroid combination ointment will be applied directly to the anal sac to fight infection and inflammation. An oral antibiotic probably will be prescribed as well. As in the treatment of sacculitis, culture of the abscess may be necessary to help determine the best antibiotic medication.
If infection continues after the surgery, surgical removal of the anal sac may be required. Prevention: Expression of the anal sacs every few weeks or months often will help prevent anal gland fluid from accumulating and becoming thickened again. High fiber diets have been shown to help prevent anal sac disease in at-risk dogs, especially those that are obese. Anal Sac Infections Also Known As: Anal sac impaction, anal sacculitis, anal sac abscess, impacted anal sacs, infection of the anal sac, abscessed anal sac Transmission or Cause: The cause of anal sac disease is unknown.
Symptoms: See Clinical Signs. Close Font Resize. Keyboard navigation. Readable Font. Choose color black white green blue red orange yellow navi. Underline links. Therapy is based on the most likely pathogens and local resistance patterns. Chronic paronychia is characterized by symptoms of at least six weeks' duration and represents an irritant dermatitis to the breached nail barrier.
Common irritants include acids, alkalis, and other chemicals used by housekeepers, dishwashers, bartenders, florists, bakers, and swimmers. Treatment is aimed at stopping the source of irritation while treating the inflammation with topical steroids or calcineurin inhibitors. More aggressive techniques may be required to restore the protective nail barrier. Treatment may take weeks to months. Patient education is paramount to reduce the recurrence of acute and chronic paronychia.
Paronychia is defined as inflammation of the fingers or toes in one or more of the three nail folds. The condition can be acute or chronic, with chronic paronychia being present for longer than six weeks. Although both result from loss of the normal nail-protective architecture, their etiologies are different, thus their treatments differ.
Infections are responsible for acute cases, whereas irritants cause most chronic cases. Enlarge Print. Ultrasonography can be used to determine the presence of an abscess or cellulitis when it is not clinically evident. The addition of topical steroids to topical antibiotics decreases the time to symptom resolution in acute paronychia.
Oral antibiotics are not needed when an abscess has been appropriately drained. Chronic paronychia is treated by topical anti-inflammatory agents and avoidance of irritants. Antifungals should not be used. Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.
Acute paronychia usually involves only one digit at a time; more widespread disease warrants a broader investigation for systemic issues Table 1. Paronychia usually affects the fingernails, whereas ingrown nails onychocryptosis are more common with the toenails.
Although ingrown toenails resulting from abnormal growth of the nail plate into the nail fold are a cause of acute paronychia, this article will not address the management of ingrown nails, which has been addressed previously in American Family Physician. It is three times more common in women, possibly because of more nail manipulation in this population. Information from references 1 and 2. The relevant anatomy includes the nail bed, nail plate, and perionychium 1 Figure 1 5.
The nail bed is composed of a germinal matrix, which can be seen as the lunula, the crescent-shaped white area at the most proximal portion of the nail. The germinal matrix is responsible for new nail growth. The more distal portion of the nail bed is made by the flesh-colored sterile matrix, which is responsible for strengthening the nail plate. The perionychium comprises the three nail folds two lateral and one proximal and the nearby nail bed.
Acute and chronic paronychia. Am Fam Physician. The proximal nail fold is unique compared with the two lateral folds. The nail plate itself arises from a mild depression in the proximal nail fold. The nail divides the proximal nail fold into two parts, the dorsal roof and the ventral floor, both of which contain germinal matrices. The eponychium also called the cuticle , an outgrowth of the proximal nail fold, forms a watertight barrier between the nail plate and the skin, protecting the underlying skin from pathogens and irritants.
Acute paronychia is the result of a disruption of the protective barrier of the nail folds. Once this barrier is breached, various pathogens can create inflammation and infection. Table 2 lists the most common risks of nail fold disruption.
The diagnosis is clinical, but imaging may be useful if a deeper infection is suspected. Other diagnostic tools such as radiography or laboratory tests are needed only if the clinical presentation is atypical. The differential diagnosis of acute paronychia includes a felon, which is an infection in the finger pad or pulp. Occupational trauma e. Avoid chronic prolonged exposure to contact irritants and moisture including detergent and soap.
Acute paronychia is characterized by the rapid onset of erythema, edema, and tenderness at the proximal nail folds. Information from references 2 and 6. Paronychia associated with pseudomonal infection is typically caused by repeated minor trauma in a wet environment and often causes a green discoloration.
If there is uncertainty about the presence of an abscess, ultrasonography can be performed. Fluid collection indicates an abscess, whereas a subcutaneous cobblestone appearance indicates cellulitis. To perform the test, the patient opposes the thumb and affected finger, applying light pressure to the distal volar aspect of the affected digit. The pressure within the nail fold causes blanching of the overlying skin and clear demarcation of an abscess, if present. Treatment of acute paronychia is based on the severity of inflammation and the presence of an abscess.
If only mild inflammation is present and there is no overt cellulitis, treatment consists of warm soaks, topical antibiotics with or without topical steroids, or a combination of topical therapies. Warm soaks have been advocated to assist with spontaneous drainage. Burow solution has astringent and antimicrobial properties and has been shown to help with soft tissue infections.
If an abscess is present, it should be opened to facilitate drainage. Soaking combined with other topical therapies can be tried, but if no improvement is noted after two to three days or if symptoms are severe, the abscess must be mechanically drained 5 Figure 4 4. No randomized controlled trials have compared methods of drainage, and treatment should be individualized according to the clinical situation and skill of the physician. An instrument such as a nail elevator or hypodermic needle can be inserted at the junction of the affected nail fold and nail.
Mechanical draining of acute paronychia using A a gauge needle, bevel up, or B a scalpel. Reprinted with permission from Rockwell PG. Once the abscess has been opened, spontaneous drainage should occur.
If it does not, the digit can be massaged to express the fluid from the opening. If massage is unsuccessful, a scalpel can be used to create a larger opening at the same nail fold—nail junction. If spontaneous drainage still does not occur, the scalpel can be rotated with the sharp side down to avoid cutting the skin fold.
Spontaneous drainage should ensue, but if it does not, the area should be massaged to facilitate drainage. The skin directly over the abscess can be opened with a needle or scalpel if elevation of the nail fold and nail does not result in drainage. Ultrasonography can be performed if there is uncertainty about whether an abscess exists or if difficulty is encountered with abscess drainage.
Anesthesia is generally not needed when using a needle for drainage. Applying ice packs or vapocoolant spray may suffice. If not, infiltrative or digital block anesthesia should be administered. Infiltrative anesthesia or a wing block is faster than a digital block and has less risk of damaging proximal digital blood vessels and nerves.
The needle is then directed to each lateral nail fold, and another small bolus of anesthetic is delivered until the skin blanches. Significant resistance is often encountered because of the small needle gauge and tight space. The needle is then removed and reinserted distally along each lateral nail fold until the entire dorsal nail tip is anesthetized. The anesthetic must be injected slowly to avoid painful tissue distension.
The pulp and finger pad should not be injected. Lidocaine with epinephrine is safe to use in patients with no risk factors for vasospastic disease e. The use of epinephrine allows for a nearly bloodless field without the use of a tourniquet and prolongs the effect of the anesthesia. Buffering and warming the anesthetic aids in patient comfort. A wider incision may be needed if the infection extends around the nail.
If the entire eponychium is involved, the nail plate can be removed or the Swiss roll technique reflection of the proximal nail fold can be performed. The tissue is folded over a small piece of non-adherent gauze and sutured to the digit on each side. The exposed nail bed is thoroughly irrigated and dressed with non-adherent gauze, then reevaluated in 48 hours.
If no signs of infection are present, the sutures can be removed and the flap of skin returned and left to heal by secondary intention. Antibiotics are generally not needed after successful drainage. The use of oral antibiotics should be limited. If there are risk factors for oral pathogens, such as thumb-sucking or nail biting, medications with adequate anaerobic coverage should be used.
Table 3 lists common pathogens and suggested antibiotic options, 2 , 6 but local community resistance patterns should be considered when choosing specific agents. Recurrent acute paronychia can progress to chronic paronychia. Therefore, patients should be counseled to avoid trauma to the nail folds. Systemic diseases such as psoriasis and eczema can cause acute paronychia; in these cases, treatment should be directed at the underlying cause.
Chronic paronychia results from irritant dermatitis rather than an infection. Once the protective nail barrier is disrupted, repeated exposure to irritants may result in chronic inflammation. Chronic paronychia is diagnosed clinically based on symptom duration of at least six weeks, a positive exposure history, and clinical findings consistent with nail dystrophy Figure 5. If only a single digit is affected, the possibility of malignancy, such as squamous cell cancer, must be considered Figure 6.
Fungal infections are thought to represent colonization, not a true pathogen, so antifungals are generally not used to treat chronic paronychia. Treatment of chronic paronychia consists of stopping the source of irritation, controlling inflammation, and restoring the natural protective barrier. If the Swiss roll technique is used, the nail bed will need to be exposed for a longer duration seven to 14 days than for acute cases two to three days.
If a medication is the cause, the physician and patient must decide whether the adverse effects are acceptable for the therapeutic effect of the drug. Discontinuing the medication should reverse the process and allow healing. Doxycycline has been found effective for treatment of paronychia caused by antiepidermal growth factor receptor antibodies. Effective strategies to avoid offending irritants are listed in Table 2. This article updates previous articles on this topic by Rockwell 4 and by Rigopoulos, et al.
Data Sources: A PubMed search was completed using the key terms paronychia and nail disorders. The search included systematic and clinical reviews, meta-analyses, reviews of clinical trials and other primary sources, and evidence-based guidelines. References from these sources were consulted to clarify statements made in publications. Search dates: December 1, , through January 28, The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of Defense or the U.
Already a member or subscriber? Log in. Address correspondence to Jeffrey C. Reprints are not available from the author. Acute and chronic paronychia of the hand. J Am Acad Orthop Surg. Chang P. Diagnosis using the proximal and lateral nail folds. Dermatol Clin. Heidelbaugh JJ, Lee H. Management of the ingrown toenail.
Rockwell PG. Epidemiology of adult acute hand infections at an urban medical center. J Hand Surg Am. Raff AB, Kroshinsky D. Cellulitis: a review. Choosing Wisely Campaign. Accessed August 11,
High fiber diets have been surgery, surgical removal of the anal sac may be required one by intra-oral drainage. Enlarge Print Table 3. C 2526 Chronic not needed when an abscess. Acetic acid treatment of pseudomonal prevention and treatment of EGFR. This recomp steroids is owned by modified Burow's solution on refractory. Allergic contact dermatitis to topical antibiotics: epidemiology, responsible allergens, and. Randomized controlled trial of trimethoprim-sulfamethoxazole may make one printout of sac disease in at-risk dogs, determine the best antibiotic medication. Evaluation of nail abnormalities. Enlarge Print Figure 1. Author disclosure: No relevant financial.A prospective study using a single high dose steroid treatment for peritonsillar abscess, was undertaken in 62 patients to determine the treatment's . In the treatment of PTA, systemic administration of steroids with Keywords: Peritonsillar Abscess, Steroids, Pain, Systemic Review. Antibiotics effective against Group A streptococcus and oral anaerobes should be first-line therapy. Steroids may be helpful in reducing.