Treatment to Prevent Recurrence of Group A Streptococcal Tonsillitis
Penicillin V for 10 days (Option A) is the correct answer to ensure prevention of recurrence and complications, as it remains the gold standard first-line treatment for Group A streptococcal pharyngitis with proven efficacy in preventing acute rheumatic fever and achieving maximal pharyngeal eradication. 1, 2
Why Penicillin V for 10 Days is Essential
Penicillin V (250 mg four times daily or 500 mg twice daily) for a full 10-day course is the recommended first-line treatment by the American Academy of Pediatrics and American Heart Association for confirmed Group A streptococcal tonsillitis 1, 2
The 10-day duration is critical to achieve maximal pharyngeal eradication of streptococci and prevent acute rheumatic fever, which is the primary objective of antibiotic therapy 1, 3
Penicillin has no documented resistance anywhere in the world against Group A Streptococcus, making it uniquely reliable 1
Shorter courses lead to treatment failure and increased risk of acute rheumatic fever, which is why the full 10-day regimen must be completed 1
Why Influenza Vaccine is Incorrect
Influenza vaccine (Option B) has no role in preventing bacterial streptococcal infections [@General Medicine Knowledge]
The patient has confirmed bacterial tonsillitis with positive throat culture and rapid strep test, which requires antibiotic treatment, not viral vaccination [@1@, @5@]
Additional Benefits of Penicillin Treatment
Antibiotics shorten symptom duration by 1-2 days and critically prevent complications including acute rheumatic fever, peritonsillar abscess, and further spread [@4@]
Treatment reduces contagion and allows faster clinical improvement [@11@]
Penicillin remains the gold standard due to its proven efficacy, narrow spectrum, safety profile, and low cost 1
Critical Management Points
Compliance is essential: The full 10-day course must be completed even if symptoms improve earlier, as skipping doses decreases effectiveness and increases likelihood of bacterial resistance [@8@]
Routine follow-up cultures are not recommended for asymptomatic patients after completing adequate therapy [@1@]
Continuous antimicrobial prophylaxis is not recommended to prevent recurrent episodes of acute pharyngitis, except for patients with a history of rheumatic fever [4, @6@]
Management of True Treatment Failures
If the patient experiences a second episode shortly after completing the 10-day penicillin course with positive testing again:
First recurrence can be retreated with the same penicillin regimen [@1@]
For multiple recurrent episodes with documented positive cultures, consider alternative regimens including clindamycin (20-30 mg/kg/day in children or 600 mg/day in adults for 10 days) or amoxicillin-clavulanate (40 mg/kg/day in 3 divided doses for 10 days) [@3@, @4@, @9@]
Clindamycin has been shown to protect patients from recurrence for at least 3 months following penicillin treatment failure and may be an alternative to tonsillectomy [@9@]
Common Pitfalls to Avoid
Do not prescribe shorter courses than the recommended 10 days (except for specific FDA-approved 5-day regimens like azithromycin), as this leads to treatment failure [@4@]
Do not withhold antibiotics in confirmed streptococcal infection, as this increases risk of rheumatic fever and other complications [@10@, 3]
Do not confuse viral pharyngitis with bacterial tonsillitis: This patient has confirmed bacterial infection requiring antibiotics [@5