What is the treatment for tonsillitis with bleeding?

From the Guidelines

The treatment for tonsillitis with bleeding requires immediate medical attention, and pain management with ibuprofen (400-600 mg every 6-8 hours) is recommended as it does not increase the risk of bleeding, according to the most recent evidence 1.

Key Considerations

• For mild bleeding, gargling with cold water or sucking on ice chips may help temporarily.
• Medical treatment typically includes antibiotics such as penicillin (500 mg twice daily for 10 days) or amoxicillin (500 mg three times daily for 10 days) if bacterial infection is suspected, as supported by recent studies on antibiotic duration 1.
• Severe bleeding may require emergency care including cauterization, surgical ligation of blood vessels, or in some cases, tonsillectomy.

Management and Prevention

• Patients should stay hydrated, rest, and avoid irritants like spicy foods, alcohol, and smoking.
• Bleeding during tonsillitis is concerning as it may indicate severe infection, potential injury to blood vessels, or rarely, more serious conditions like peritonsillar abscess.
• If bleeding persists or is heavy, emergency medical care should be sought immediately as significant blood loss can occur rapidly from the tonsillar region.

Evidence-Based Recommendations

• The use of NSAIDs, such as ibuprofen, in children was not associated with an increased risk of bleeding, secondary bleeding, readmissions, or need for reoperation due to bleeding, as shown in a study involving 1747 children 1.
• A review from the Cochrane Collaboration found that NSAIDs did not significantly increase the risk of bleeding as compared with placebo or other analgesics, and resulted in less vomiting 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Tonsillitis with Bleeding

• Tonsillitis is an inflammation of the tonsils, which can be caused by viral or bacterial infections 2.
• In cases of bacterial tonsillitis, antibiotics such as penicillin are prescribed as the first-line treatment 2, 3.
• Spontaneous tonsillar bleeding is a rare but potentially life-threatening complication of tonsillitis, with a higher incidence in young patients and a higher mortality rate 4, 5.

Treatment Options

• For recurrent acute pharyngo-tonsillitis, antibiotics such as clindamycin and amoxicillin with clavulanate may be effective in preventing future episodes and eradicating group A streptococci from the tonsils 6.
• In cases of spontaneous tonsillar bleeding, a management plan should be formulated to address the potentially fatal condition 4.
• Antibiotic treatment may be an option for patients with recurrent acute pharyngo-tonsillitis who have contraindications for tonsillectomy 6.

Specific Considerations

• The use of dispersible tablets of amoxicillin + clavulanic acid may have a higher safety profile compared to film-coated tablets in the treatment of acute streptococcal tonsillopharyngitis 3.
• Infectious mononucleosis is a rare cause of spontaneous tonsillar hemorrhage, and reported cases indicate an increased incidence in young patients with a higher mortality rate 5.