Overview
Acute bacterial tonsillitis is characterized by inflammation of the tonsils primarily caused by Streptococcus pyogenes, leading to symptoms such as sore throat, fever, and tonsillar exudates. 1Diagnosis
Clinical presentation including sore throat, fever, and tonsillar swelling or exudates.
Throat culture or rapid antigen detection test (RADT) for S. pyogenes confirmation.
White blood cell count often elevated, though not specific.
C-reactive protein (CRP) levels may be elevated in severe cases. 1Management
First-line treatment: Penicillin V (250 mg orally four times daily for 10 days) or amoxicillin (500 mg orally three times daily for 10 days). 1
Alternative for penicillin allergy: Cephalexin (500 mg orally four times daily for 10 days) or clindamycin (300-450 mg orally four times daily for 10 days).
Macrolides: Reserved for cases of macrolide-sensitive S. pyogenes infection; avoid due to increasing resistance (e.g., erythromycin resistance increased from 14% to 32% from 1997 to 2001). 1Special Populations
Pregnancy: Penicillin V or amoxicillin remain first-line options; avoid clindamycin unless necessary due to potential side effects.
Pediatrics: Dosage adjusted by weight; amoxicillin preferred due to better palatability and efficacy.
Elderly: Monitor for complications; consider renal function when dosing antibiotics like cephalexin.
Comorbidities: No specific adjustments noted; focus on treating underlying conditions and monitoring response to therapy. 1Key Recommendations
Initiate empirical treatment with penicillin V or amoxicillin for suspected S. pyogenes tonsillitis (Evidence: Strong 1).
Avoid routine use of macrolides due to rising resistance rates (Evidence: Moderate 1).
Consider alternative antibiotics like cephalexin for patients with penicillin allergies (Evidence: Moderate 1).References
1 Urbánek K, Kolár M, Cekanová L. Utilisation of macrolides and the development of Streptococcus pyogenes resistance to erythromycin. Pharmacy world & science : PWS 2005. link