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. The choice of antibiotic is crucial in managing tonsillitis, particularly when caused by Group A Streptococcus, to prevent complications such as acute rheumatic fever and peritonsillar abscess.

• Key considerations include:
  • The patient's allergy status, with alternatives such as roxithromycin or cephalexin for those allergic to penicillin.
  • The severity of the infection, with amoxicillin-clavulanate considered for severe cases or when there's no improvement after 48-72 hours.
  • The importance of confirming bacterial infection through a throat swab for culture before initiating antibiotic therapy, as most cases of tonsillitis are viral in nature.
• Supportive care measures, including adequate hydration, pain relief with paracetamol or ibuprofen, and rest, are essential for all patients with tonsillitis, regardless of whether antibiotics are prescribed.
• Completing the full course of antibiotics is critical to prevent antibiotic resistance and potential complications. The guidelines emphasize the need for accurate diagnosis and appropriate antimicrobial therapy to prevent unnecessary exposure to antibiotics and the development of antimicrobial resistance 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

Recommended Antibiotics for Tonsillitis

According to various studies, the following antibiotics are recommended for the treatment of tonsillitis:

• Penicillin V (Phenoxymethyl Penicillin) 1000 mg daily, usually 500 mg twice a day for 10 days 3
• Cephalosporins, which have been shown to be superior to penicillin in eradicating group A beta-hemolytic Streptococcus, and can be effective when administered for 4 to 5 days 4
• Macrolides, such as clarithromycin and azithromycin, which are rational alternatives to erythromycin for streptococcal pharyngitis/tonsillitis in penicillin-allergic patients 5
• Amoxicillin, which has been shown to be effective in the treatment of acute tonsillitis and/or pharyngitis due to beta-hemolytic streptococci 6

Australian Guidelines

While the provided studies do not specifically mention Australian guidelines, they do provide information on the recommended treatment for tonsillitis:

• Penicillin V is widely recommended as the first-line treatment for streptococcal tonsillitis 3
• Alternative antibiotics, such as cephalosporins and macrolides, may be considered in cases where penicillin is not effective or in patients who are allergic to penicillin 4, 5

Variability in Treatment Regimens

There is significant variability in the treatment regimens prescribed by primary care physicians for acute tonsillitis, despite wide consensus regarding the recommended antibiotic treatment 3

• Different antibiotics and dosages may be prescribed, and there may be no explanations for these differences in the medical files 3