From the Guidelines
Treat tonsillitis when there are at least 7 episodes in the past year, at least 5 episodes per year for 2 years, or at least 3 episodes per year for 3 years with documentation of sore throat and one of the following: temperature > 38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus.
Key Considerations
- The decision to treat tonsillitis should be based on the frequency and severity of episodes, as well as the presence of certain clinical features, such as fever, cervical adenopathy, and tonsillar exudate 1.
- Watchful waiting is recommended for patients with fewer than 7 episodes in the past year, fewer than 5 episodes per year in the past 2 years, or fewer than 3 episodes per year in the past 3 years 1.
- A minimum of 12 months of observation is recommended before considering tonsillectomy in patients without factors that suggest a high risk of complications or a significant impact on quality of life 1.
- Documentation of recurrent throat infections is crucial in determining the need for tonsillectomy, and should include the presence of a sore throat plus findings from a subjective physician assessment, such as fever, pharyngeal or tonsillar erythema, tonsil size, tonsillar exudate, cervical adenopathy, and microbiologic test results 1.
Clinical Features and Treatment
- Clinical features that support the diagnosis of tonsillitis include sore throat, temperature > 38.3°C, cervical adenopathy, tonsillar exudate, and positive test for group A beta-hemolytic streptococcus 1.
- Treatment of tonsillitis typically involves antibiotics, such as penicillin or amoxicillin, for patients with a positive test for group A beta-hemolytic streptococcus 1.
- Tonsillectomy may be considered for patients who meet the criteria for recurrent throat infection, but the decision should be made on a case-by-case basis, taking into account the potential benefits and harms of the procedure 1.
From the Research
Treatment of Tonsillitis
Tonsillitis can be caused by viral or bacterial infections, with group A beta-hemolytic streptococcus (Streptococcus pyogenes) being a common bacterial cause 2, 3, 4. The treatment approach depends on the underlying cause of the infection.
Viral Tonsillitis
- Viral tonsillitis is usually treated with supportive care, as it is a self-limited disease 3, 5.
- Symptomatic treatment is often sufficient for viral tonsillitis, with no need for antibiotics.
Bacterial Tonsillitis
- Bacterial tonsillitis, particularly those caused by group A beta-hemolytic streptococcus, require antibiotic treatment to prevent complications such as acute rheumatic fever and glomerulonephritis 2, 4, 5.
- Penicillin is the first-line antibiotic for treating streptococcal tonsillitis 2, 3, 4.
- Other antibiotics may be used in certain cases, such as in patients with penicillin allergy or resistance 3, 4.
Recurrent Tonsillitis
- Watchful waiting is recommended for patients with recurrent tonsillitis, unless they have a high frequency of episodes 2.
- The decision to treat or not treat recurrent tonsillitis depends on the number of episodes per year and the patient's overall health status.
Diagnosis and Treatment Guidelines
- The Centor score is a validated scoring system used to diagnose streptococcal pharyngitis and tonsillitis 2, 6.
- Adherence to national guidelines for antibiotic prescribing is essential to prevent overuse and misuse of antibiotics 6.
- Accurate diagnosis and treatment are crucial to prevent complications and reduce the risk of antibiotic resistance 2, 3, 4, 6, 5.