Individualized therapy approach in patients with peritonsillar abscessThis work was supported by a fellowship of the medical faculty at the University of Muenster, Germany and by grants of the IMF (Innovative Medizinische Forschung) of the medical faculty at the University of Muenster to C. S. (SP 2 1 15 11)
18. April 2018 (online)
In addition to abscess-tonsillectomy and abscess-incision or drainage, patients with milder symptoms of peritonsillar abscess (PTA) benefit from antibiotic therapy. To date, however, there exists no objective instrument that allows an adequate division of patients into the therapeutic regimes.
Serum and saliva of patients with peritonsillar inflammation were analyzed concerning the concentration of a broad range of cytokines, chemokines and soluble proteins, such as IL-1ß, IL-8 TNF-α and S100A8/A9, using an enzyme-linked immunosorbent assay (ELISA) and cytometric bead arrays. A PTA score was developed by combining the biomarker S100A8/A9 with determined clinical characteristics (halitosis, trismus, uvula edema and palatine asymmetry). A retrospective analysis of the new developed PTA score and the applied therapy approach was performed.
Solely S100A8/A9 showed the potential as a biomarker for the PTA among the determined cytokines, chemokines and soluble proteins. With a range of minimum 0 and maximum 6 points, the PTA score has the potential to identify a PTA with a sensitivity of 92% and a specificity of 93%. In addition, patients with a PTA score of ≤2 benefit from medical therapy whereas a PTA score > 2 indicates the need for abscess relief. The early selection of the correct therapy strategy leads to a reduced duration of hospitalization from 7 to 4 days in median.
The application of the novel PTA score allows to determine an individualized therapy approach in patients with PTA and thus prevents unnecessary stressful interventions. Furthermore, a significant cost reduction can be achieved by consecutive reduction of hospital bed-days and therapy costs.