What antibiotics are recommended for tonsillitis according to Australian guidelines?

From the Guidelines

For tonsillitis in Australia, the recommended first-line antibiotic is phenoxymethylpenicillin (penicillin V) at 500mg orally every 12 hours for 10 days for adults, or 10mg/kg up to 500mg every 12 hours for children, as supported by the Infectious Diseases Society of America guidelines 1.

Key Considerations

• Antibiotics are only recommended for bacterial tonsillitis, particularly when caused by Group A Streptococcus, as most cases are viral and will resolve without antibiotics.
• Bacterial tonsillitis is more likely if the patient has fever, tender cervical lymphadenopathy, tonsillar exudate, and absence of cough.
• Treatment aims to reduce symptom duration, prevent complications like peritonsillar abscess, and reduce transmission.

Alternative Antibiotics

• If the patient has a penicillin allergy, roxithromycin (300mg once daily for adults, 4mg/kg up to 150mg twice daily for children) or clarithromycin (250mg twice daily for adults, 7.5mg/kg up to 250mg twice daily for children) are appropriate alternatives for a 10-day course.

Symptomatic Relief

• Symptomatic relief with adequate hydration, rest, and appropriate pain relief is also important during recovery.

Evidence Base

• The recommendation is based on the Infectious Diseases Society of America guidelines 1, which provide a comprehensive review of the evidence for the diagnosis and management of group A streptococcal pharyngitis.
• The guidelines emphasize the importance of accurate diagnosis and appropriate antimicrobial therapy to prevent complications and reduce transmission.
• A study published in the Clinical Microbiology and Infection journal also supports the use of penicillin as the first choice for acute sore throat 1.

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. The recommended antibiotic for tonsillitis according to the provided information is azithromycin, with a dosage of 12 mg/kg once daily for 5 days for children aged 2 years and above 2.

• The dosage is calculated based on body weight, with the following guidelines:
  • 8-17 kg: 2.5 mL (½ tsp) per day
  • 17-25 kg: 5 mL (1 tsp) per day
  • 25-35 kg: 7.5 mL (1½ tsp) per day
  • 35-40 kg: 10 mL (2 tsp) per day
  • 40 kg and above: 12.5 mL (2½ tsp) per day

From the Research

Australian Guidelines for Tonsillitis Treatment

There are no specific Australian guidelines mentioned in the provided studies. However, the studies discuss various antibiotic treatments for tonsillitis:

• Penicillin is often considered the first-line treatment for streptococcal tonsillopharyngitis 3, 4, 5
• Alternative antibiotics such as cephalosporins and macrolides may be used in cases of penicillin allergy or resistance 3, 4, 6
• Shorter courses of antibiotics, such as 5-day courses of cefuroxime axetil, may be effective in treating tonsillopharyngitis 6

Recommended Antibiotics

The following antibiotics are recommended for tonsillitis treatment:

• Penicillin V for 10 days 3, 5, 6
• Cefuroxime axetil for 5 days 6
• Macrolides such as clarithromycin and azithromycin for patients allergic to penicillin 4
• Erythromycin, although its use is complicated by gastrointestinal side effects 4

Considerations for Treatment

When treating tonsillitis, consider the following:

• The cause of tonsillitis, whether viral or bacterial 5
• The patient's age and potential for recurrent infections 6
• The risk of poststreptococcal sequelae such as glomerulonephritis and rheumatic fever 5, 6
• The potential for antibiotic resistance and the need for alternative treatments 3, 4, 6