What is the treatment for bacterial tonsillitis?

From the Guidelines

The primary treatment for bacterial tonsillitis is penicillin, due to its proven efficacy, safety, narrow spectrum, and low cost, as recommended by North American and many European guidelines. According to the guideline for the management of acute sore throat 1, penicillin has been the treatment of choice for group A b-haemolytic streptococcal pharyngitis for five decades. The standard regimen for adults is penicillin V 500 mg orally twice daily for 10 days. For children, dosing is weight-based, usually amoxicillin 40-50 mg/kg/day divided into three doses, although penicillin V is also an option.

Some studies have suggested that cephalosporins may be more effective than penicillin in reducing sore throat symptoms, but the differences in efficacy are not clinically important 1. Additionally, a systematic review comparing efficacy and safety of azithromycin against other antibiotics for acute pharyngitis in adults and children found no evidence of differing efficacy between azithromycin and comparator agents, including penicillin 1.

Key points to consider when treating bacterial tonsillitis include:

• Completing the full course of antibiotics, even if symptoms improve earlier, to prevent recurrence and complications
• Providing supportive care, including adequate hydration, rest, over-the-counter pain relievers like acetaminophen or ibuprofen for pain and fever, and warm salt water gargles to soothe the throat
• Monitoring for potential complications, such as rheumatic fever, kidney inflammation, or peritonsillar abscess, and seeking medical reassessment if symptoms don't improve within 48-72 hours of starting antibiotics, or if they worsen.

It's also important to note that for patients with penicillin allergy, alternatives include clindamycin 300 mg three times daily for 10 days, or azithromycin 500 mg on day one followed by 250 mg daily for four more days, as these options can provide effective treatment while minimizing the risk of adverse reactions.

From the FDA Drug Label

In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS)

The treatment for bacterial tonsillitis is azithromycin (12 mg/kg once a day for 5 days) or penicillin V (250 mg three times a day for 10 days).

• Clinical success rates for azithromycin were 98% at Day 14 and 94% at Day 30.
• Bacteriologic efficacy rates for azithromycin were 95% at Day 14 and 77% at Day 30. 2

From the Research

Treatment Options for Bacterial Tonsillitis

• Antibiotics are commonly prescribed for the treatment of bacterial tonsillitis, with penicillin being a frequently recommended option 3.
• Amoxicillin + clavulanic acid has been shown to be effective in treating acute streptococcal tonsillopharyngitis, with a high therapeutic efficacy and a safer profile compared to film-coated tablets 4.
• Clindamycin and amoxicillin with clavulanate have been found to be superior to penicillin in preventing future attacks of acute pharyngo-tonsillitis and eradicating group A streptococci from the tonsils 5.
• Azithromycin has been evaluated as a potential treatment option for pediatric tonsillitis, showing a high clinical success rate and low occurrence of adverse reactions 6.

Comparison of Antibiotic Regimens

• A study comparing amoxycillin/clavulanate potassium with penicillin-V potassium found that amoxycillin/clavulanate potassium was more effective in eradicating group A beta-haemolytic streptococci and preventing recurrent infection 7.
• Another study found that clindamycin and cefpodoxime were effective in preventing future episodes of acute pharyngo-tonsillitis and eradicating group A streptococci from the tonsils 5.
• The choice of antibiotic regimen may depend on various factors, including the severity of the infection, patient age, and presence of allergies or contraindications 3.

Adherence to Treatment Guidelines

• A study found significant variability in antibiotic prescribing practices among primary care physicians for the treatment of acute tonsillitis, despite wide consensus on the recommended treatment 3.
• Adherence to treatment guidelines is important to ensure proper care and prevent health complications, as well as to reduce unnecessary antibiotic use and promote antibiotic stewardship 5, 3.