What is the treatment for tonsillitis in a 1-year-old?

From the Guidelines

The treatment for tonsillitis in a 1-year-old typically involves supportive care and possibly antibiotics if the cause is bacterial, with a focus on keeping the child comfortable and hydrated, as recommended by the most recent guidelines 1.

Key Considerations

• For mild cases, focus on keeping your child comfortable with acetaminophen (Tylenol) at a dose of 10-15 mg/kg every 4-6 hours to reduce pain and fever.
• Ensure adequate hydration by offering frequent small sips of cool liquids or popsicles.
• If a bacterial infection is confirmed through a throat culture or rapid strep test, your doctor may prescribe antibiotics such as amoxicillin at 40-50 mg/kg/day divided into two doses for 10 days.

Important Recommendations

• It's crucial to complete the full course of antibiotics even if symptoms improve, as emphasized in the guidelines 1.
• Most viral tonsillitis cases resolve on their own within 7-10 days without antibiotics.
• Contact your doctor immediately if your child has difficulty breathing, excessive drooling, severe difficulty swallowing, or appears dehydrated.

Tonsillectomy Considerations

• Tonsillectomy may be considered in recurrent throat infections if they have had at least seven documented episodes of sore throat in the previous year, at least five documented episodes in each of the previous two years, or at least three documented episodes in each of the previous three years, plus a temperature of greater than 100.9°F (38.3°C), cervical adenopathy, exudate, or a positive culture for group A β-hemolytic streptococcus, as suggested by the guidelines 1.
• However, the decision to perform a tonsillectomy should be made on a case-by-case basis, taking into account the individual child's circumstances and the potential benefits and harms of the procedure, as recommended by the most recent guidelines 1.

From the Research

Tonsillitis Organisms in 1-Year-Old Children

• The most common cause of tonsillitis in children is a viral infection, accounting for 70% to 95% of cases 2.
• Bacterial infections, particularly group A beta-hemolytic streptococcus (Streptococcus pyogenes), are also a common cause of tonsillitis in children, especially in those over 6 years old 3.
• In children under 4 years old, beta-hemolytic streptococci are relatively uncommon, accounting for only 18% of cases 3.

Treatment of Tonsillitis in 1-Year-Old Children

• The treatment of tonsillitis in children focuses on supportive care, and if group A beta-hemolytic streptococcus is identified, penicillin should be used as the first-line antibiotic 2.
• Alternative antibiotics, such as macrolides (e.g., clarithromycin and azithromycin), may be used in patients allergic to penicillin 4.
• Short-term late-generation antibiotic therapy (e.g., azithromycin, clarithromycin, or cephalosporine for 3 to 5 days) is comparable to long-term penicillin therapy in terms of symptom reduction and primary healing 5, 6.
• However, only 10-day antibiotic therapy has been proven to be effective in preventing rheumatic fever and glomerulonephritic diseases 5, 6.

Diagnosis of Tonsillitis in 1-Year-Old Children

• The diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections 5, 6.
• Rapid antigen testing has a low sensitivity in diagnosing bacterial tonsillitis, while swabs are highly sensitive but take a long time 5, 6.
• Microbiological screening tests in children without symptoms are not recommended, as most bacteria, viruses, and fungi belong to the healthy flora and do not cause harm 5, 6.