What is the treatment for exudative tonsillitis?

From the Guidelines

The treatment for exudative tonsillitis typically involves antibiotics, particularly if the cause is bacterial (such as group A Streptococcus), with Penicillin V (phenoxymethylpenicillin) being the first-line treatment, usually prescribed as 500 mg twice daily for 10 days for adults, or weight-based dosing for children, as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The choice of antibiotic should be based on the likelihood of a bacterial infection, with group A Streptococcus being a common cause of exudative tonsillitis.
• Patients with penicillin allergy may require alternative antibiotics, such as erythromycin or clindamycin.
• Supportive care, including adequate hydration, rest, and pain management, is equally important in the treatment of exudative tonsillitis.
• The American College of Physicians and the Centers for Disease Control and Prevention recommend antibiotic therapy only for patients with a positive streptococcal test result 1.

Treatment Options

• Penicillin V (phenoxymethylpenicillin): 500 mg twice daily for 10 days for adults, or weight-based dosing for children.
• Amoxicillin: 50 mg/kg once daily (maximum 1 g) for 10 days.
• Erythromycin: 500 mg four times daily for 10 days (for patients with penicillin allergy).
• Clindamycin: 300 mg three times daily for 10 days (for patients with penicillin allergy).

Important Notes

• Patients should complete the full course of antibiotics even if symptoms improve to prevent complications like rheumatic fever or peritonsillar abscess.
• If symptoms worsen despite treatment, or if the patient develops difficulty breathing or swallowing, immediate medical attention is necessary as this may indicate complications requiring more aggressive intervention.
• The American Academy of Pediatrics recommends that clinicians may recommend tonsillectomy for recurrent throat infection with a frequency of at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation in the medical record for each episode of sore throat and 1 of the following: temperature ≥38.3°C (101°F), cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 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 Azithromycin is often effective in the eradication of susceptible strains of Streptococcus pyogenes from the nasopharynx Because some strains are resistant to azithromycin, susceptibility tests should be performed when patients are treated with azithromycin.

The treatment for exudative tonsillitis is azithromycin as an alternative to first-line therapy in individuals who cannot use first-line therapy, caused by Streptococcus pyogenes.

• Key points:
  • Azithromycin is effective in eradicating susceptible strains of Streptococcus pyogenes from the nasopharynx.
  • Susceptibility tests should be performed when patients are treated with azithromycin due to potential resistance. 2

From the Research

Treatment for Exudative Tonsillitis

The treatment for exudative tonsillitis depends on the cause of the infection.

• If the cause is bacterial, specifically group A beta-hemolytic streptococcus (GABHS), antibiotics are prescribed 3, 4, 5, 6, 7.
• Penicillin V is the standard therapy for GABHS pharyngitis and is effective in managing the infection 3, 5, 6, 7.
• However, there are alternative antibiotic treatments available, such as azithromycin and clarithromycin, which have simpler and shorter dosing regimens compared to penicillin V 3, 4, 7.
• A 5-day course of azithromycin or clarithromycin can be as effective as a 10-day course of penicillin V in eradicating GABHS 3, 4, 7.
• Cefuroxime axetil is also an effective alternative to penicillin V, especially in young children 6.

Antibiotic Treatment Options

• Azithromycin: 10-12 mg/kg/day for 3-5 days 3, 7
• Clarithromycin: 500 mg once daily for 5 days 4
• Cefuroxime axetil: 20 mg/kg/day for 5 days 6
• Penicillin V: 50,000 IU/kg (30 mg/kg) three times daily for 10 days 3, 5, 6, 7

Supportive Care

• Supportive care, such as rest, hydration, and pain management, is also important in treating exudative tonsillitis 5.