What injection is good for tonsillitis?

Treatment of Tonsillitis: Appropriate Injections and Management

For bacterial tonsillitis, penicillin is the first-line treatment, with intramuscular penicillin benzathine being the recommended injection when oral compliance is a concern. 1, 2

Diagnosis Before Treatment

• Before administering any injection or medication, it's crucial to determine whether the tonsillitis is bacterial or viral, as antibiotics should only be prescribed for confirmed bacterial cases, particularly Group A Streptococcus (GAS) 1
• Bacterial tonsillitis typically presents with sudden onset of sore throat, fever >38°C, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough 3
• Rapid antigen detection testing (RADT) and/or throat culture for Group A Streptococcus should be performed to confirm bacterial infection before initiating antibiotics 1, 3

Injectable Treatment Options

• For confirmed bacterial tonsillitis with concerns about oral medication compliance, penicillin benzathine intramuscular injection is recommended 2
  • Dosage: 600,000 U in single dose for patients under 27 kg
  • Dosage: 1,200,000 U in single dose for patients 27 kg or more 2
• A single intraoperative dose of dexamethasone injection is recommended for pain relief in surgical cases of tonsillitis 1

Oral Antibiotic Options (When Injections Are Not Preferred)

• Penicillin V for 10 days is the first-line oral treatment for confirmed GAS tonsillitis 1, 3
• Amoxicillin for 10 days is an acceptable alternative first-line treatment with better taste for children 3, 2
• The standard 10-day course of antibiotics is necessary to maximize bacterial eradication and prevent complications like rheumatic fever 1, 3

Treatment for Penicillin-Allergic Patients

• For patients with non-anaphylactic penicillin allergy, first-generation cephalosporins are recommended 2
• For patients with anaphylactic penicillin allergy, options include: 2, 4
  • Clindamicin: 7 mg/kg/dose three times daily for 10 days
  • Azithromycin: 12 mg/kg once daily for 5 days
  • Erythromycin: 30-50 mg/kg/day in divided doses for at least 10 days 4

Symptomatic Relief

• Either ibuprofen or paracetamol are recommended for relief of acute sore throat symptoms 5
• A single dose of corticosteroids in conjunction with antibiotic therapy may benefit adults with severe sore throat, though evidence for benefit in children is limited 5

Common Pitfalls to Avoid

• Initiating antibiotic therapy without confirming GAS infection through testing 3
• Using broad-spectrum antibiotics when narrow-spectrum penicillins are effective for confirmed GAS 3
• Prescribing shorter courses of penicillin (less than 10 days) for GAS tonsillitis, which increases risk of treatment failure 3, 6, 7
• Failure to consider beta-lactamase-producing bacteria as a cause of penicillin treatment failure in recurrent cases 7

Management of Recurrent Tonsillitis

• For patients with recurrent episodes of documented bacterial tonsillitis, consider alternative regimens such as clindamycin, amoxicillin-clavulanate, or penicillin benzathine injection with rifampicin 2, 7
• Tonsillectomy should be considered when episodes meet Paradise criteria: 7+ episodes in the preceding year, 5+ episodes per year for 2 consecutive years, or 3+ episodes per year for 3 consecutive years 1, 3