Clinical definition:
Infection causing acute inflammation of the pharyngeal wall and tonsils caused by various classes of S. pyogenes or C. diphtheriae (diphtheria). Common symptoms include sore throat; low-grade fever; and inflammation of the tonsils, uvula, lymph nodes, submandibular region, and neck.
| Preferred antibiotic choice(s) | |||
| Drug | Formulation | Dosage | Duration |
| Phenoxymethyl-penicillin (penicillin V) (PO) | Powder for oral liquid: 250 mg (as potassium salt)/5 mL; Tablet: 250 mg (as potassium salt) | 500 mg 6 hourly | 5 days |
| Amoxicillin (PO) | Powder for oral liquid: 125 mg (as trihydrate)/5 mL; 250 mg (as trihydrate)/5 mL; Solid oral dosage form: 250 mg; 500 mg (as trihydrate) | 500 mg 8 hourly | 5 days |
| In case of confirmed severe penicillin allergy or medical contraindication | |||
| Azithromycin (PO) | Capsule: 250 mg; 500 mg (anhydrous); Oral liquid: 200 mg/5 mL | 500 mg daily | 3 days |
Principles of Stewardship:
- 85% or more of pharyngotonsillitis cases are viral. Most cases of pharyngotonsillitis in adults should be managed with watchful waiting & symptomatic relief. Antibiotics should not be considered unless there is a confirmed diagnosis of group A Streptococcus.
Notes:
- If clinical findings or epidemiologic context suggest diphtheria, treat with diphtheria antitoxin in addition to penicillin or macrolide.