From the Guidelines
For tonsillitis, the most commonly prescribed antibiotics are penicillin-based medications like amoxicillin (500 mg three times daily for 10 days) or penicillin V (500 mg twice daily for 10 days), as recommended by the Infectious Diseases Society of America 1. When considering treatment options, it's essential to determine if the tonsillitis is caused by bacteria, particularly Group A Streptococcus, which accounts for about 15-30% of cases. A throat swab test can help identify the presence of bacteria. Some key points to consider when treating tonsillitis include:
- Completing the full course of antibiotics, even if symptoms improve
- Drinking plenty of fluids
- Resting
- Using over-the-counter pain relievers like acetaminophen or ibuprofen for discomfort If a patient has a penicillin allergy, alternative antibiotics like azithromycin (500 mg on day 1, then 250 mg daily for 4 more days) or clindamycin (300 mg three times daily for 10 days) can be used 1. It's crucial to note that most tonsillitis cases are viral and won't respond to antibiotics, making it essential to accurately diagnose the cause of the infection before starting treatment. The American Heart Association also recommends penicillin-based medications as the first line of treatment for streptococcal tonsillopharyngitis, with alternatives available for patients with penicillin allergies 1. Overall, the choice of antibiotic should be based on the severity of the infection, patient allergies, and the potential for resistance.
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 In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes)
The antibiotics used to treat tonsillitis are:
- Azithromycin 2
- Penicillin V 2 Note that penicillin is usually the first-line therapy, and azithromycin is used as an alternative for individuals who cannot use penicillin.
From the Research
Antibiotics Used to Treat Tonsillitis
- Penicillin is the primary drug of choice for treating tonsillitis, particularly for group A beta-hemolytic streptococcal tonsillopharyngitis 3, 4, 5
- For patients allergic to penicillin, alternatives such as erythromycin, clarithromycin, and azithromycin may be used 3
- Macrolides like clarithromycin and azithromycin offer advantages over erythromycin, including lower rates of gastrointestinal side effects and more convenient dosing regimens 3
- Cephalosporins have been shown to be effective in eradicating group A beta-hemolytic Streptococcus and may be preferable in some cases, especially when administered for shorter courses of 4 to 5 days 4, 6
- Short-course therapy with antibiotics like amoxicillin, cephalosporins, and macrolides (e.g., azithromycin) has been found to be as effective as, or even superior to, traditional 10-day penicillin therapy in treating group A beta-hemolytic streptococcal pharyngotonsillitis 6