title: Impact of anti-inflammatory drug consumption in peritonsillar abscesses: a retrospective cohort study.
abstract: The experience of clinicians in charge of the in-hospital management of peritonsillar abscesses supports the association between severe forms and anti-inflammatory drug (AID) consumption. However, this observation is based on a limited number of clinical studies. Our objective was to assess the prevalence and impact of AID consumption in patients with peritonsillar abscesses.
  
  
  
  All patients referred to the ear, nose and throat surgery department for a peritonsillar abscess were included in a retrospective cohort study (2012-2014).
  
  
  
  Among the 216 included patients (male, 55 %; median age, 32 years [IQR, 26-40]), 127 had received AID (59 %), including corticosteroids (n = 67, 31 %) and/or non-steroidal AIDs (NSAIDs, n = 76, 35 %). 199 patients (92 %) benefit from a puncture and 5 (2 %) from a surgery under general anesthesia, associated with ceftriaxone/metronidazole (51 %) or amoxicillin/clavulanic acid (46 %). An iterative surgical procedure was required in 93 cases (43 %), including 19 % under general anesthesia. Bacteriological analysis (79 %) mainly disclosed streptococci (66 %) of A (18 %) and/or milleri (33 %) groups. The prevalence of anaerobes was higher in patients using AIDs (46 % versus 29 %, p = 0.034), regardless of prior antibiotic therapy. 65 patients benefited from a CT-scan; AID consumption was associated with larger abscesses (6.8 [IQR, 3.7-12.7] versus 2.9 [IQR, 0.9-7.8] cm(3); p = 0.005). AID consumption was not a risk factor of iterative surgical procedure.
  
  
  
  In comparison to the prescribing habits in uncomplicated upper respiratory tract infection, the high prevalence of AID consumption in patients with peritonsillar suppuration suggests a role of AIDs in promoting these complications.
authors.affiliation: General Medicine Department, Claude Bernard Lyon 1 University, Lyon, France.|Infectious Disease Department, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Feasson
authors.affiliation: ENT Surgery Department, Groupement Hospitalier Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Debeaupte
authors.affiliation: Department of Radiology, Centre Hospitalier de Valence, Valence, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Bidet
authors.affiliation: Infectious Disease Department, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Claude Bernard Lyon 1 University, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Ader
authors.affiliation: ENT Surgery Department, Groupement Hospitalier Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.|Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Disant
authors.affiliation: Infectious Disease Department, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Claude Bernard Lyon 1 University, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Ferry
authors.affiliation: Infectious Disease Department, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.|Claude Bernard Lyon 1 University, Lyon, France.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Chidiac
authors.affiliation: Infectious Disease Department, Groupement Hospitalier Nord, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. florent.valour@chu-lyon.fr.|Claude Bernard Lyon 1 University, Lyon, France. florent.valour@chu-lyon.fr.|INSERM U1111, International Center for Research in Infectiology (CIRI), Claude Bernard Lyon 1 University, Lyon, France. florent.valour@chu-lyon.fr.
authors.forename: Florent
authors.identifier: 0000-0002-1467-6162
authors.initials: F
authors.lastname: Valour
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D000039:Peritonsillar Abscess / Q000139:chemically induced* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013291:Streptococcus / Q000302:isolation & purification
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D008795:Metronidazole; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone
keywords: Anti-inflammatory drugs; Corticosteroids; Nonsteroidal anti-inflammatory drugs; Pharyngeal infection; Tonsillar abscess