Pharyngitis/tonsillitis (including peritonsillar abscess and group A strep throat infection)
- See NICE guideline 84 - Sore throat (acute): antimicrobial prescribing
- Consider EBV serology. If positive and no signs of bacterial infection STOP antibiotics
- HIV Antibody/antigen testing is recommended
- Consider use of the FeverPAIN or Centor score when deciding if antibiotic treatment is required (see below)
- Treat for 5-10 days. If Group A strep is isolated treat for 10 days.
- Suspected peritonsillar abscess should be referred to ENT urgently for evaluation and source control
Preferred
Mild/moderate disease, suitable for out-patient treatment or for oral switch after initial IV therapy
phenoxymethyl penicillin (penicillin V) 500mg po qds (or 1g po bd if this would help adherence)
Severe disease, including peritonsillar abscess (review potential for oral switch daily)
benzylpenicillin 1.2g iv qds
Alternative
Consider Delabelling of spurious penicillin allergy in patients who are low risk and are clinically stable.
For penicillin allergy (non-severe and severe)
clarithromycin 500mg po bd (iv if NBM)
If pregnant: erythromycin 500mg po qds
Additional Information
Consider use of the FeverPAIN or Centor score when deciding if antibiotic treatment is required
FeverPAIN (1 point per criteria):
- Fever (during previous 24 hours)
- Purulence (pus on tonsils)
- Attend rapidly (within 3 days after onset of symptoms)
- Severely Inflamed tonsils
- No cough or coryza (inflammation of mucus membranes in the nose)
Centor (1 point per criteria):
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever (over 38 degrees Celsius)
- Absence of cough
Rationale for antibiotics:
|
FeverPAIN score |
Centor score |
Recommendations |
|
0-1 |
0-2 |
Antibiotics NOT recommended |
|
2-3 |
|
Considered delayed antibiotic prescription |
|
4-5 |
3-4 |
Consider immediate or delayed antibiotic prescription |