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
- Staying hydrated
- Using over-the-counter pain relievers like acetaminophen or ibuprofen for discomfort
- Gargling with warm salt water to soothe the throat 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, as suggested by the American Heart Association 1. It's crucial to note that most tonsillitis cases are viral and won't respond to antibiotics, and the use of antibiotics should be guided by the results of a throat swab test to minimize unnecessary antibiotic use and prevent the development of antibiotic resistance, as highlighted in the guideline for the management of acute sore throat 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 NOTE: Penicillin by the intramuscular route is the usual drug of choice in the treatment of Streptococcus pyogenes infection and the prophylaxis of rheumatic fever. 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
- Erythromycin may also be used, especially in patients who are allergic to penicillin and sulfonamides 3 Note that penicillin is usually the first choice for treating Streptococcus pyogenes infections.
From the Research
Antibiotics Used to Treat Tonsillitis
- Penicillin is the most commonly recommended antibiotic for treating tonsillitis, particularly for group A beta-hemolytic streptococcal tonsillitis 4, 5, 6, 7
- Alternatives to penicillin include:
- Macrolides such as erythromycin, clarithromycin, and azithromycin, which are effective but may have gastrointestinal side effects 4
- Cephalosporins, which have been shown to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus and can be administered for 4 to 5 days 5, 7
- Clindamycin and amoxicillin-clavulanate, which have also been found to be effective in eradicating the infection 7
Considerations for Antibiotic Treatment
- The choice of antibiotic may depend on factors such as patient allergy, compliance, and the presence of other bacterial strains that may interfere with treatment 4, 5, 7
- Shortened courses of antibiotics, such as 4 to 5 days, may be effective in some cases, particularly with cephalosporins 5
- Treatment failure may occur due to various reasons, including lack of compliance, reexposure to infected individuals, copathogenicity, and penicillin tolerance 5, 7