From the Guidelines
Treatment for tonsillitis without a positive strep test should focus on symptom management, as most cases are viral in nature, and antibiotics are not recommended unless there are severe symptoms or complications, as suggested by 1 and 1.
Symptom Management
To manage symptoms, start with over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to reduce pain and fever, as recommended by 1.
- Gargling with warm salt water (1/2 teaspoon salt in 8 ounces of water) several times daily can soothe throat discomfort.
- Stay well-hydrated with cool liquids and consider throat lozenges containing benzocaine or menthol for temporary relief.
- Rest is essential to support your immune system's fight against the infection.
When to Seek Medical Attention
If symptoms are severe or persist beyond 7-10 days, worsen after initial improvement, or if you develop difficulty breathing or swallowing, seek medical attention as antibiotics might be necessary despite the negative strep test, as indicated by 1.
- Viral tonsillitis typically resolves on its own within 7-10 days as your body clears the infection, which is why supportive care rather than antibiotics is the primary approach for non-strep cases.
- The use of antibiotics is generally not recommended for patients with a negative strep test, unless there are specific circumstances that suggest a bacterial infection, as outlined in 1 and 1.
From the FDA Drug Label
Pharyngitis/tonsillitis caused by Streptococcus pyogenes as an alternative to first-line therapy in individuals who cannot use first-line therapy. The FDA drug label does not answer the question about treatment for tonsillitis without strep positive.
From the Research
Treatment for Tonsillitis without Strep Positive
- The treatment for tonsillitis without a strep positive diagnosis is focused on supportive care, as most cases are caused by viral infections 2.
- According to the study published in the American Family Physician, watchful waiting is strongly recommended for recurrent tonsillitis if there have been less than seven episodes in the past year, less than five episodes per year for the past two years, or less than three episodes per year for the past three years 2.
- The use of antibiotics is not recommended for viral tonsillitis, as it can lead to bacterial resistance and treatment failure 3.
- A study published in the European Archives of Oto-Rhino-Laryngology suggests that a diagnostic scoring system, such as the Centor or McIsaac score, can be used to estimate the probability of tonsillitis caused by β-hemolytic streptococci 4.
- If the score is ≥3, a pharyngeal swab or rapid test or culture can be performed to identify β-hemolytic streptococci, and first-line therapy with oral penicillin can be initiated if the test is positive 4.
Supportive Care
- Supportive care for tonsillitis without a strep positive diagnosis includes rest, hydration, and pain management 2.
- A study published in the Harefuah journal found that there is significant variability in the prescribing practices of primary care physicians for acute tonsillitis, highlighting the need for adherence to guidelines and proper treatment protocols 5.
- The study published in the Prilozi journal emphasizes the importance of evidence-based practice in using antibiotics for acute tonsillitis, and notes that only patients with acute tonsillitis caused by Group A beta-hemolytic streptococcus (GAS) benefit from antibiotic treatment 3.
Antibiotic Use
- Antibiotics should only be used in cases where the tonsillitis is caused by a bacterial infection, such as Group A beta-hemolytic streptococcus (GAS) 6, 4.
- The use of antibiotics for viral tonsillitis can lead to bacterial resistance and treatment failure, and is not recommended 3.
- A study published in the Current Infectious Disease Reports journal notes that penicillin V remains the drug of choice for acute tonsillitis, but other antibiotics may be approved and recommended for particular indications in both Europe and the United States 6.