Consider infectious mononucleosis send an EBV IgM test to virology and/or request monospot from haematology.

Required investigations

  • Bacterial throat swab
  • Pus aspirate for culture and sensitivities
  • Blood cultures

Antimicrobial recommendations

Recommended total duration: 7 days post drainage of abscess

Antimicrobial recommendation

Benzylpenicillin 1.2g every 4 hours IV

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

Penicillin-allergy / Previous MRSA

Vancomycin (use NHS Lothian Calculator located AMT intranet page)

PLUS

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route unavailable)

 

IV to oral switch

First line

Phenoxymethylpenicillin 500mg every 6 hours orally

PLUS

Metronidazole 400mg every 8 hours orally
Penicillin Allergy Phone microbiology

 

Notes

Likely organisms:

  • Streptococci species including:
    • Strep. pyogenes (group A Strep),
    • Group C or G Streptococci,
    • milleri/anginosus group Streptococci may be isolated.
  • Anaerobes including Fusobacterium spp.
  • Staphylococcus aureus is occasionally implicated.