A 52-year-old woman presents with a 4-day history of severe sore throat, odynophagia, and trismus. She cannot swallow her saliva and is drooling. She appears systemically unwell with a muffled "hot potato" voice.
On examination, she is febrile (39.1°C) and tachycardic (HR 108 bpm). Her mouth opening is limited to 2cm due to trismus. The oropharynx reveals right-sided peritonsillar swelling with the soft palate displaced medially and the uvula deviated to the left. There is no stridor, and she can handle her secretions when sitting upright.
What is the MOST appropriate management?
Start PO penicillin V & metronidazole, arrange GP review in 48 hours
Perform immediate needle aspiration in the ED, start PO co-amoxiclav
Start IV benzylpenicillin & metronidazole, arrange urgent ENT review
Perform immediate incision and drainage under local anaesthetic in ED
Start PO dexamethasone to reduce swelling, arrange an ENT OPD review