What is the medical treatment for adult tonsillitis (inflammation of the tonsils)?

From the Guidelines

The treatment for adult tonsillitis typically depends on whether it's viral or bacterial in origin, with viral tonsillitis being managed with symptom relief and bacterial tonsillitis, particularly strep throat, requiring antibiotics. For viral tonsillitis, which is most common, treatment focuses on symptom management with rest, adequate hydration, warm salt water gargles, and over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) 1.

Key Considerations

• For bacterial tonsillitis, particularly strep throat, antibiotics are necessary, with Penicillin V (500mg twice daily for 10 days) or amoxicillin (500mg three times daily for 10 days) being first-line treatments 1.
• For penicillin-allergic patients, alternatives include clindamycin (300mg three times daily for 10 days) or azithromycin (500mg on day 1, then 250mg daily for 4 more days) 1.
• It's crucial to complete the full antibiotic course even if symptoms improve quickly to prevent complications like rheumatic fever or kidney inflammation.
• Severe cases with difficulty breathing, swallowing, or persistent symptoms may require hospitalization for IV antibiotics or surgical evaluation.
• Recurrent tonsillitis (more than 7 episodes in one year, 5 yearly episodes for two consecutive years, or 3 yearly episodes for three consecutive years) might warrant consideration of tonsillectomy after consultation with an otolaryngologist 1.

Symptom Management

• Adult patients with sore throat should be offered analgesic therapy, such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges, which can help reduce pain 1.
• Salt water, viscous lidocaine, and other mixtures are often used in clinical practice for topical pain relief, but there are few data examining these approaches 1.

Diagnostic Approach

• Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis by rapid antigen detection test and/or culture for group A Streptococcus 1.
• Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1.

From the FDA Drug Label

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 primary endpoint of this trial was prospectively defined as the clinical cure rate at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS):

Three U. S. Streptococcal Pharyngitis Studies

Azithromycin vs. Penicillin V

EFFICACY RESULTS

Day 14 Day 30

Bacteriologic Eradication:

Azithromycin 323/340 (95%) 255/330 (77%)

Penicillin V 242/332 (73%) 206/325 (63%)

Clinical Success (Cure plus improvement):

Azithromycin 336/343 (98%) 310/330 (94%)

Penicillin V 284/338 (84%) 241/325 (74%)

The medical treatment for adult tonsillitis (inflammation of the tonsils) is azithromycin. The recommended dosage is not explicitly stated for adults in the provided text, but for pediatric patients, it is 12 mg/kg on Days 1 to 5.

• Key points:
  • Azithromycin is effective in treating pharyngitis/tonsillitis due to Group A β-hemolytic streptococci.
  • The clinical success rate for azithromycin is 98% at Day 14 and 94% at Day 30.
  • Bacteriologic eradication rates for azithromycin are 95% at Day 14 and 77% at Day 30.
  • Azithromycin is compared to penicillin V in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci. 2

From the Research

Medical Treatment for Adult Tonsillitis

The medical treatment for adult tonsillitis typically involves a combination of medications and surgical options.

• The primary goal of treatment is to relieve symptoms, shorten the duration of the illness, and prevent complications 3, 4, 5, 6, 7.
• Antibiotic therapy is usually prescribed for bacterial tonsillitis, with penicillin being the drug of choice 3, 5, 6.
• For patients allergic to penicillin, alternative antibiotics such as macrolides (e.g., clarithromycin, azithromycin) or cephalosporins may be used 3, 5.
• The duration of antibiotic treatment typically ranges from 5 to 10 days, depending on the specific antibiotic and the severity of the infection 3, 5, 6.
• Pain management is also an essential aspect of treatment, with options including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and topical anesthetics 4, 5.
• In cases of recurrent acute tonsillitis, tonsillectomy may be considered as a surgical option, especially if the patient has experienced ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years 4.
• Topical drugs, such as benzalkonium chloride + tyrothricin + benzocaine (Dorithyrcin), may also be used to relieve symptoms and shorten the duration of the disease 5.

Diagnosis and Treatment Approach

• Diagnosis of acute tonsillitis is typically clinical, and it can be challenging to distinguish viral from bacterial infections 7.
• Rapid antigen testing and bacterial cultures may be used to aid in diagnosis, but their sensitivity and specificity can vary 3, 5, 7.
• A scoring system, such as the Centor or McIssac score, can be used to estimate the probability of bacterial tonsillitis and guide treatment decisions 4, 5.
• The treatment approach should be individualized based on the patient's specific needs and circumstances, taking into account factors such as the severity of symptoms, the presence of underlying medical conditions, and the patient's preferences and values 4, 5, 6, 7.