From the Guidelines
Penicillin V is the recommended first-line antibiotic treatment for bacterial tonsillitis, typically prescribed at 250 mg 4 times daily or 500 mg twice daily for 10 days for adults, and 250 mg twice daily or 3 times daily for children, as stated in the 2012 update by the Infectious Diseases Society of America 1. The treatment of bacterial tonsillitis, specifically Group A Streptococcal pharyngitis, is crucial to prevent complications such as acute rheumatic fever and suppurative complications, as well as to reduce symptom duration and contagiousness.
- The dosage and duration of penicillin V treatment are based on the patient's age and weight, with a strong, high-quality recommendation from the Infectious Diseases Society of America 1.
- For patients with penicillin allergy, alternative antibiotics such as cephalexin, cefadroxil, clindamycin, azithromycin, or clarithromycin can be used, with a strong, high or moderate recommendation depending on the specific antibiotic and patient population 1.
- It is essential to complete the full course of antibiotics, even if symptoms improve before completion, to prevent recurrence and antibiotic resistance.
- Supportive measures, including adequate hydration, rest, and pain management with acetaminophen or ibuprofen, should accompany antibiotic therapy to improve the patient's quality of life and reduce morbidity.
- The diagnosis of bacterial tonsillitis should be based on clinical presentation and confirmed by rapid strep testing or throat culture to ensure accurate diagnosis and appropriate treatment.
From the FDA Drug Label
Pharyngitis/Tonsillitis The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days.
PEDIATRIC DOSAGE GUIDELINES FOR PHARYNGITIS/TONSILLITIS (Age 2 years and above, see PRECAUTIONS—Pediatric Use.) Based on Body Weight PHARYNGITIS/TONSILLITIS: (5-Day Regimen) Dosing Calculated on 12 mg/kg/day for 5 days.
The recommended antibiotic treatment for bacterial tonsillitis is azithromycin at a dose of 12 mg/kg once daily for 5 days 2.
- Key points:
- The dosage is calculated based on body weight.
- The treatment duration is 5 days.
- Azithromycin is the recommended antibiotic for pharyngitis/tonsillitis in pediatric patients aged 2 years and above.
- Note: The effectiveness of azithromycin in treating bacterial tonsillitis has been demonstrated in clinical trials, with high clinical success rates and bacteriologic efficacy rates 2.
From the Research
Antibiotic Treatment for Bacterial Tonsillitis
The recommended antibiotic treatment for bacterial tonsillitis is as follows:
- Penicillin is the drug of choice for the treatment of group A beta-hemolytic streptococcal tonsillitis, as stated in the study 3.
- For patients allergic to penicillin, alternatives such as erythromycin, clarithromycin, and azithromycin may be used, with the newer macrolides offering lower rates of gastrointestinal complaints and more convenient dosing 3.
- However, the effectiveness of penicillin has been questioned in recent years, with studies showing that the bacteriologic failure rate of penicillin therapy can range from 2 to 30% 4.
- Other antibiotics, such as cephalosporins, have been demonstrated to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus, and may be effective when administered for 4 to 5 days 4.
- The use of ampicillin + sulbactam, combined with daily cleaning of tonsillar lesions, has also been shown to decrease the clinical recovery time of acute tonsillitis 5.
Causes of Penicillin Treatment Failure
The primary causes of penicillin treatment failure in streptococcal tonsillopharyngitis include:
- Lack of compliance with the 10-day therapeutic regimen 4
- Reexposure to Streptococcus-infected family members or peers 4
- Copathogenicity, in which bacteria susceptible to a class of drugs are protected by other, colocalized bacterial strains that lack the same susceptibility 4
- Antibiotic-associated eradication of normal protective pharyngeal flora 4
- Penicillin tolerance, whereby streptococcal bacteria repeatedly or continuously exposed to sublethal concentrations of antibiotic become increasingly resistant to eradication 4
- Beta-lactamase-producing bacteria (BLPB) that "shield" GABHS by inactivating penicillin 6
Alternative Treatment Options
Alternative treatment options for patients who have failed penicillin therapy include: