From the Guidelines
The management of tonsillitis in Australia typically involves supportive care and, in some cases, antibiotics, with a focus on symptom relief and prevention of complications, as outlined in the guidelines from the American College of Physicians and the Centers for Disease Control and Prevention 1.
Key Considerations
- For mild viral tonsillitis, treatment focuses on symptom relief with regular paracetamol (15mg/kg up to 1g QID) or ibuprofen (10mg/kg up to 400mg TID), adequate hydration, and rest.
- For suspected bacterial tonsillitis, particularly group A streptococcal infection, phenoxymethylpenicillin (500mg for adults, 10mg/kg for children BID) for 10 days is the first-line antibiotic, as recommended by the Infectious Diseases Society of America 1.
- For penicillin-allergic patients, roxithromycin (300mg daily for adults, 4mg/kg for children) or cephalexin (if non-anaphylactic allergy) can be used.
- Tonsillectomy may be considered for patients with recurrent tonsillitis (7+ episodes in one year, 5+ episodes per year for two years, or 3+ episodes per year for three years) or complications like peritonsillar abscess, as outlined in the guidelines from the American Academy of Otolaryngology-Head and Neck Surgery 1.
Important Factors to Consider
- Most cases of tonsillitis are viral and self-limiting, resolving within 7-10 days without antibiotics.
- Antibiotics are primarily indicated when bacterial infection is suspected based on clinical features like exudative tonsils, fever >38°C, tender cervical lymphadenopathy, and absence of cough, or for high-risk patients with rheumatic heart disease or immunosuppression.
- The decision to perform a tonsillectomy should be made after careful consideration of the potential benefits and harms, and after documentation of recurrent throat infections, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
From the FDA Drug Label
Penicillin is considered by the American Heart Association to be the drug of choice in the prevention of initial attacks of rheumatic fever (treatment of Streptococcus pyogenes infections of the upper respiratory tract e.g., tonsillitis, or pharyngitis). Erythromycin tablets are indicated for the treatment of penicillin-allergic patients. The therapeutic dose should be administered for ten days.
The management of tonsillitis in Australia is not explicitly stated in the provided drug labels. However, for patients with tonsillitis caused by Streptococcus pyogenes, the treatment options are:
- Penicillin as the first-line treatment,
- Erythromycin for patients allergic to penicillin, with a therapeutic dose administered for at least 10 days 2.
From the Research
Management of Tonsillitis in Australia
The management of tonsillitis in Australia involves the use of antibiotics to treat the infection.
- The choice of antibiotic depends on the severity of the infection and the patient's medical history.
- According to 3, a 5-day course of clarithromycin is comparable to a 10-day course of penicillin V in eradicating Streptococcus pyogenes.
- Another study 4 found that cefprozil has a less inhibitory effect on alpha-hemolytic streptococci compared to other antibiotics.
Antibiotic Treatment Options
Several antibiotic treatment options are available for the management of tonsillitis in Australia, including:
- Penicillin V: a commonly used antibiotic for the treatment of tonsillitis, especially in patients with a history of rheumatic fever 5.
- Clarithromycin: a macrolide antibiotic that has been shown to be effective in eradicating Streptococcus pyogenes 3.
- Cefuroxime axetil: a cephalosporin antibiotic that has been shown to be effective in treating tonsillopharyngitis caused by group A beta-hemolytic streptococci 6.
- Amoxicillin/clavulanate: a broad-spectrum antibiotic that has been shown to be effective in treating recurrent acute pharyngo-tonsillitis 7.
Recurrent Acute Pharyngo-Tonsillitis
For patients with recurrent acute pharyngo-tonsillitis, antibiotic treatment may be necessary to prevent future attacks.
- A systematic review 7 found that clindamycin and amoxicillin with clavulanate are superior to penicillin in preventing future attacks of acute pharyngo-tonsillitis.
- Another study 4 found that cefprozil is effective in eradicating group A beta-hemolytic streptococci and has a less inhibitory effect on alpha-hemolytic streptococci.