What antibiotic is used to treat tonsillitis?

From the Guidelines

For patients with tonsillitis caused by Group A Streptococcus, Penicillin V is the recommended first-line antibiotic treatment, typically prescribed at 250 mg 4 times daily or 500 mg twice daily for 10 days for adolescents and adults, and 250 mg twice daily or 3 times daily for children, as stated in the 2012 update by the Infectious Diseases Society of America 1.

Key Considerations

• The diagnosis of Group A Streptococcal pharyngitis should be established through accurate diagnosis, as only 20%–30% of children and a smaller percentage of adults with acute pharyngitis have GAS pharyngitis 1.
• Antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to organisms other than GAS, and inappropriate antimicrobial use can lead to the development of antimicrobial resistance among common pathogens 1.
• For individuals with penicillin allergy, alternative antibiotics such as Cephalexin, Cefadroxil, Clindamycin, Azithromycin, or Clarithromycin can be used, as recommended in the guideline 1.

Treatment Options

• Penicillin V: 250 mg 4 times daily or 500 mg twice daily for 10 days for adolescents and adults, and 250 mg twice daily or 3 times daily for children 1.
• Amoxicillin: 50 mg/kg once daily (max = 1000 mg) or 25 mg/kg (max = 500 mg) twice daily for 10 days 1.
• Cephalexin: 20 mg/kg/dose twice daily (max = 500 mg/dose) for 10 days, for individuals with penicillin allergy 1.

Important Reminders

• Complete the full course of antibiotics even if symptoms improve to prevent complications like rheumatic fever or kidney inflammation.
• Stay hydrated, rest adequately, and use over-the-counter pain relievers like acetaminophen or ibuprofen to manage pain and fever.
• Treatment is only necessary if a throat swab confirms bacterial infection or if clinical signs strongly suggest it, as most tonsillitis cases are viral and don't require antibiotics.

From the FDA Drug Label

Pharyngitis/Tonsillitis The recommended dose of azithromycin for children with pharyngitis/tonsillitis is 12 mg/kg once daily for 5 days.

PEDIATRIC DOSAGE GUIDELINES FOR PHARYNGITIS/TONSILLITIS (Age 2 years and above, see PRECAUTIONS—Pediatric Use.)

Based on Body Weight PHARYNGITIS/TONSILLITIS: (5-Day Regimen) Dosing Calculated on 12 mg/kg/day for 5 days.

The recommended antibiotic for tonsillitis is azithromycin, with a dosage of 12 mg/kg once daily for 5 days for children aged 2 years and above 2.

• The dosage is calculated based on body weight, with the following guidelines:

• 8-17 kg: 2.5 mL (½ tsp) per day
• 17-25 kg: 5 mL (1 tsp) per day
• 25-35 kg: 7.5 mL (1½ tsp) per day
• 35-40 kg: 10 mL (2 tsp) per day
• 40 kg and above: 12.5 mL (2½ tsp) per day

• The treatment duration is 5 days.
• It is essential to follow the recommended dosage and treatment duration to ensure effective treatment of tonsillitis.

From the Research

Antibiotic Treatment for Tonsillitis

• The recommended antibiotic treatment for tonsillitis caused by group A beta-hemolytic streptococci (GABHS) is penicillin V, with a treatment duration of 10 days 3.
• However, studies have shown that shorter courses of antibiotics, such as cefuroxime axetil for 5 days, can be as effective as penicillin V for 10 days in eradicating GABHS tonsillopharyngitis 4.
• Other antibiotics, such as cephalosporins, clindamycin, macrolides, and amoxicillin-clavulanate, have been found to be more effective than penicillin in eradicating GABHS tonsillitis, especially in patients who have failed previous penicillin therapy 5, 6, 3.
• The choice of antibiotic should be based on the patient's medical history, including any allergies or previous treatment failures, as well as the severity of the infection 7.

Factors Affecting Antibiotic Treatment

• Patient compliance with a 10-day course of antibiotic therapy can be poor, leading to treatment failure 4, 3.
• The presence of beta-lactamase-producing bacteria (BLPB) can interfere with the effectiveness of penicillin therapy, leading to treatment failure 5, 6.
• Recurrent infections can occur due to various factors, including poor patient compliance, re-infection, and bacterial interference 5, 6, 3.

Diagnosis and Treatment Guidelines

• Clinical score systems, such as the Centor score and McIssac score, can help clinicians decide which patients should undergo diagnostic testing for GABHS pharyngitis 7.
• Microbiologic testing, such as culture or rapid antigen detection test, should be performed to confirm the diagnosis of GABHS pharyngitis before initiating antimicrobial therapy 7.
• Antimicrobial therapy should be initiated without delay once the diagnosis is confirmed, and the choice of antibiotic should be based on the patient's medical history and the severity of the infection 7.