From the Guidelines

Tonsillitis is typically treated with antibiotics if caused by a bacterial infection, and pain management is crucial for symptom relief.

The treatment approach depends on the underlying cause of tonsillitis, which can be either viral or bacterial 1.
For bacterial tonsillitis, antibiotics such as penicillin or amoxicillin are commonly prescribed to treat the infection.
Pain management is essential for patients undergoing tonsillectomy, with guidelines recommending a procedure-specific postoperative pain management approach 1.

A basic analgesic regimen is recommended for efficacy evaluation in post-tonsillectomy pain management 1.
The choice of pain medication and dosage depends on the individual patient's needs and medical history.

Antibiotics are only effective against bacterial infections, and their use should be guided by a thorough diagnosis to avoid unnecessary treatment 1.
The most common bacterial cause of tonsillitis is Streptococcus pyogenes (group A b-haemolytic streptococcus), and antibiotics can help prevent complications such as acute rheumatic fever or acute glomerulonephritis 1.

From the Research

The treatment for tonsillitis can be divided into two main categories: non-surgical and surgical treatment.

Non-surgical treatment includes:
- Conservative management with paracetamol and/or non-steroidal anti-inflammatory drugs 2
- Antibiotic treatment in cases of high probability of bacterial tonsillitis, especially in patients at risk 2, 3
- Topical drugs, such as benzalkonium chloride + tyrothricin + benzocaine, for relief of sore throat and shortening of the disease duration 3
Surgical treatment includes:
- Tonsillectomy, which is indicated in cases of recurrent acute tonsillitis with ≥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 2
- Adenotonsillectomy, which is a common ENT operation, but the indications for surgery are controversial 4
- Tonsillotomy, which is characterized by a substantially lower postoperative morbidity in terms of pain and bleeding compared to tonsillectomy 5

The indications for surgical treatment of tonsillitis include:

Recurrent episodes of acute tonsillitis, with a modest impact of tonsillectomy on the number of sore throat episodes per year in children 4, 5
Peritonsillar abscess, which can be treated with needle aspiration, incision and drainage, or abscess tonsillectomy 5
Infectious mononucleosis, where tonsillectomy is not recommended as a routine procedure for symptom control, but may be indicated in cases with clinically significant upper airway obstruction resulting from inflammatory tonsillar hyperplasia 5

When considering treatment for tonsillitis, it is essential to:

Assess the probability of bacterial tonsillitis using a scoring system, such as the Centor or McIssac score, and consider a point-of-care test GAS swab test in ambiguous cases 2
Evaluate the patient's quality of life using a specific score, such as the Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument 2
Consider the potential risks and benefits of surgical treatment, including postoperative pain and bleeding, and the impact on quality of life 4, 5