Bacterial Pharyngotonsillitis, including Streptococcal & Diphtheria

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.


  • If clinical findings or epidemiologic context suggest diphtheria, treat with diphtheria antitoxin in addition to penicillin or macrolide.