What is the recommended treatment for a 29-week pregnant woman with tonsillitis?

Treatment of Tonsillitis in a 29-Week Pregnant Woman

Penicillin antibiotics are the first-line treatment for tonsillitis in a 29-week pregnant woman, with cephalosporins as an appropriate alternative for those with penicillin allergy. 1, 2

Antibiotic Selection

• Penicillins are the safest antibiotic class during pregnancy and should be used as first-line therapy for tonsillitis 2
• Cephalosporins are an appropriate alternative for patients with penicillin allergy 2, 1
• Avoid tetracyclines, aminoglycosides, trimethoprim-sulfamethoxazole, and fluoroquinolones during pregnancy due to potential fetal risks 1, 2
• Macrolides can be considered as third-line agents if both penicillins and cephalosporins cannot be used 2

Diagnostic Considerations

• Tonsillitis is viral in 70-95% of cases, but bacterial infections (primarily group A beta-hemolytic streptococcus) account for 5-15% of cases in adults 3
• Consider using validated scoring systems (e.g., Centor score) to help differentiate bacterial from viral causes 3
• Testing for group A streptococcus is important as untreated streptococcal infections can lead to complications that may affect both mother and fetus 3, 4

Treatment Approach

For Bacterial Tonsillitis:

• Penicillin V (phenoxymethylpenicillin) is the first-line antibiotic 3, 2
• Amoxicillin is an appropriate alternative with good coverage and safety profile 2
• For penicillin-allergic patients, first-generation cephalosporins are recommended if the allergy is not anaphylactic 1, 2
• Complete the full course of antibiotics (typically 10 days) to ensure eradication of the infection 4

For Symptomatic Relief:

• Saline gargles are safe and may provide symptomatic relief 1
• Acetaminophen (paracetamol) can be used for pain and fever control 1
• Adequate hydration and rest are important supportive measures 3
• Avoid oral decongestants as they may increase risks during pregnancy 1

Special Considerations in Pregnancy

• Untreated infections during pregnancy can lead to complications including preterm labor and delivery 2
• The benefits of appropriate antibiotic treatment outweigh the potential risks when bacterial tonsillitis is suspected 2, 4
• Consider consultation with an obstetrician for pregnant women with severe infections or complications 1
• Test of cure may be advisable after treatment completion to ensure resolution of infection 5

Common Pitfalls to Avoid

• Delaying treatment of suspected bacterial tonsillitis can lead to complications affecting both mother and fetus 2, 4
• Using contraindicated antibiotics such as tetracyclines after the fifth week of pregnancy 2
• Inadequate duration of antibiotic therapy, which may lead to treatment failure or recurrence 4
• Failing to differentiate between viral and bacterial causes, leading to unnecessary antibiotic use 3
• Not considering potential drug interactions with other medications the pregnant woman may be taking 6