What are the IDSA treatment guidelines for tonsillitis and peritonsillar abscess (PTA)?

Updated: Apr 06, 2020
  • Author: Udayan K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
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ISDA guideline recommendations for treatment include the following [17] :

  • Patients with confirmed GAS pharyngitis should be treated for a duration likely to eradicate GAS from the pharynx (usually 10 days) with an appropriate narrow-spectrum antibiotic
  • Penicillin or amoxicillin is the drug of choice for those without a contraindication
  • Alternative agents for penicillin-allergic individuals include a first-generation cephalosporin, clindamycin, or clarithromycin for 10 days, or azithromycin for 5 days 
  • An analgesic such as acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID) may be considered as an adjunct to an appropriate antibiotic for treatment of moderate to severe symptoms or control of high fever; aspirin should be avoided in children
  • Adjunctive therapy with a corticosteroid is not recommended
  • In patients with recurrent episodes of pharyngitis, consider the possibility that they are a chronic pharyngeal GAS carrier who is experiencing repeated viral infections
  • Efforts to identify GAS carriers are not justified because they have a low risk of transmitting GAS pharyngitis to their close contacts and little or no risk for the development of acute rheumatic fever
  • Tonsillectomy is not recommended to reduce the frequency of GAS pharyngitis

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