What are the recommended antibiotics for treating bacterial tonsillitis?

From the Guidelines

Penicillin V (phenoxymethylpenicillin) is the recommended first-line antibiotic treatment for bacterial tonsillitis, typically prescribed at 250-500 mg twice or three times daily for 10 days for adults and children, depending on weight. For patients with penicillin allergy, alternatives include narrow-spectrum cephalosporins, clindamycin, azithromycin, or clarithromycin 1. The choice of antibiotic should be based on the patient's medical history, allergy status, and local resistance patterns. It's essential to complete the full course of antibiotics even if symptoms improve within a few days to prevent recurrence and complications, such as rheumatic fever 1. Before starting antibiotics, a rapid strep test or throat culture is recommended to confirm bacterial infection, as most cases of tonsillitis are viral and don't require antibiotics 1.

Some key points to consider when treating bacterial tonsillitis include:

• The importance of completing the full course of antibiotics to prevent recurrence and complications
• The need for a rapid strep test or throat culture to confirm bacterial infection before starting antibiotics
• The potential for penicillin allergy and the need for alternative antibiotics in these cases
• The importance of considering local resistance patterns when choosing an antibiotic

According to the guidelines, penicillin V and amoxicillin are effective against Group A Streptococcus, which is the most common cause of bacterial tonsillitis 1. For patients with penicillin allergy, narrow-spectrum cephalosporins, such as cephalexin or cefadroxil, can be used as alternatives 1. Macrolides, such as azithromycin or clarithromycin, can also be used, but resistance rates may vary geographically and temporally 1.

In terms of dosage and duration, the guidelines recommend:

• Penicillin V: 250-500 mg twice or three times daily for 10 days
• Amoxicillin: 50 mg/kg once daily (maximum 1 g) for 10 days
• Cephalexin: 20 mg/kg/dose twice daily (maximum 500 mg/dose) for 10 days
• Azithromycin: 12 mg/kg once daily (maximum 500 mg) for 5 days
• Clarithromycin: 7.5 mg/kg/dose twice daily (maximum 250 mg/dose) for 10 days 1.

It's essential to note that these recommendations are based on the most recent and highest-quality evidence available, and clinicians should always consult the latest guidelines and consider local resistance patterns when making treatment decisions 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Recommended Antibiotics for Bacterial Tonsillitis

The following antibiotics are recommended for treating bacterial tonsillitis:

• Penicillin is the drug of choice 2, 3, 4
• For patients allergic to penicillin, alternatives such as erythromycin, clarithromycin, and azithromycin may be used 2, 4
• Cephalosporins have also been shown to be effective in eradicating group A beta-hemolytic Streptococcus 3
• Short-term late-generation antibiotic therapy (azithromycin, clarithromycin, or cephalosporine for three to five days) is comparable to long-term penicillin therapy in terms of symptom reduction and primary healing 5

Factors to Consider When Choosing an Antibiotic

When selecting an antibiotic for bacterial tonsillitis, the following factors should be considered:

• Patient allergy history 2, 4
• Effectiveness of the antibiotic against group A beta-hemolytic Streptococcus 3
• Duration of treatment, with options ranging from 5-10 days 2, 3, 5
• Potential side effects, such as gastrointestinal complaints 2

Additional Considerations

Other considerations in the management of tonsillitis include:

• The use of steroids (e.g. dexamethasone) and NSAIDs (e.g. ibuprofen) for symptom relief 5
• The potential need for surgical referral in cases of recurrent tonsillitis or other complications 5, 4
• The importance of proper diagnosis and differentiation between viral and bacterial tonsillitis 5, 6