TABLE 118.2 ANTIBIOTIC OPTIONS FOR ACUTE BACTERIAL RHINOSINUSITIS CLINICAL PEARLS AND PITFALLS Peritonsillar abscess (PTA) is the most common deep neck infection in adolescents Imaging is not necessary in most cases of PTA, but is occasionally warranted when the diagnosis is unclear Older patients treated with incision and drainage of a PTA can often be discharged from the ED Current Evidence Pharyngitis/tonsillitis (pharyngotonsillitis) may be caused by viral or bacterial organisms Rapid strep tests have short turnaround times (5 to 10 minutes) and may be helpful in confirming a bacterial source, but may miss up to a quarter of infections If this test result is negative and bacterial infection is still suspected, a routine throat culture is often helpful Patients with repeated debilitating bouts of pharyngotonsillitis or complications including PTA should be referred to an otolaryngologist for consideration of tonsillectomy Specifically, according to the Paradise criteria, tonsillectomy should be considered for patients who have had infections in year, infections/yr for years, or infections/yr for years For more information on pharyngitis, see Chapter 74 Sore Throat