From the Guidelines
The patient shows improvement in his tonsillitis after completing a course of clarithromycin, and no further antibiotic treatment is needed at this time. The follow-up CBC demonstrates a decreasing white blood cell count (from 17.4 to 14.3) with a shift from neutrophil to lymphocyte predominance, indicating resolution of the bacterial infection 1. Physical examination confirms clinical improvement with reduced tonsil erythema, and the patient reports no throat pain or fever. The persistent tonsillar enlargement is expected and may take several weeks to completely resolve.
The patient should continue with supportive care including:
- Adequate hydration
- Rest
- Over-the-counter pain relievers if needed for any residual discomfort If symptoms worsen or new symptoms develop such as difficulty breathing or swallowing, immediate medical attention should be sought. The shift from neutrophil to lymphocyte predominance in the CBC is a normal finding during recovery from bacterial infections, as neutrophils (which rise during acute infection) decrease while lymphocytes (involved in longer-term immune response) become more prominent.
According to the clinical practice guideline: tonsillectomy in children (update) 1, watchful waiting is recommended for recurrent throat infection if there have been fewer than 7 episodes in the past year. However, in this case, the patient has already shown improvement with antibiotic treatment, and tonsillectomy is not immediately necessary. The patient's condition should continue to be monitored, and further evaluation and treatment should be guided by the clinical practice guideline 1.
From the Research
Patient Follow-up
- The patient, a 10-year-old male, returned for a follow-up of tonsillitis after completing a course of clarithromycin 5ml every 12 hours from April 30,2025, to May 10,2025.
- The patient's mother reported that the patient had completed the course of antibiotics as prescribed.
- The patient's symptoms had improved, with no more throat pain and no fever.
Laboratory Results
- A repeat CBC was performed, showing:
- WBC: 14.30 ( decreased from 17.4)
- Neutrophils: 41 (decreased from 66.90)
- Lymphocytes: 55 (increased from 27.10)
- Platelets: 223
- The patient's laboratory results indicate a decrease in WBC and neutrophils, suggesting a response to the antibiotic treatment 2, 3, 4.
Physical Examination
- The patient still had enlarged bilateral tonsils, but with lesser erythema compared to before.
- The patient's physical examination results suggest that the infection is still present, but the severity has decreased 2, 3, 4.
Comparison of Antibiotics
- Studies have compared the efficacy of azithromycin and clarithromycin in the treatment of upper respiratory tract infections, including tonsillitis 5, 6.
- Azithromycin has been shown to be as effective as clarithromycin in the treatment of tonsillitis, with a shorter course of treatment (3 days vs 10 days) 6.
- Clarithromycin has been shown to be effective in the treatment of tonsillitis, with a broad spectrum of antimicrobial activity 2, 3, 4.