Treatment of Acute Streptococcal Tonsillitis in Children Ages 3–14 When Penicillin Has Not Worked
This protocol addresses the specific situation in which a child aged 3–14 with acute tonsillitis — caused by β-hemolytic streptococci (group A, C, or G) and a McIsaac score of at least 3 — has not become free of symptoms within 48 hours of starting a first-line penicillin regimen.
β-Hemolytic streptococcal infection (group A, C, or G) · McIsaac score ≥ 3 · Age 3–14 years · No penicillin allergy or incompatibility
A first-line oral penicillin — either Penicillin V or Phenoxymethylpenicillin–Benzathin — was used but the patient did not become free of symptoms within 48 hours. Failure to reach that goal triggers escalation to this next treatment step.
An oral cephalosporin is indicated in this situation. The complete structured regimen — specifying the agent and how it is to be applied — is available in the full protocol.
Antibiotic therapy is indicated only in case of a highly suspected or proven β-hemolytic streptococci infection (of group A, C, or G).
For patients with sore throat in times and regions without epidemic occurrence of β-hemolytic streptococcal infection, a low regional incidence of streptococcal sequelae and a McIsaac-Score of at least 3, oral medication is recommended as follows — Age 3–14 years:
Only very selected indications support administration of oral cephalosporins (for example: cefadroxil, cefalexin) including the failure of penicillin V, frequent recurrences, and whenever a more reliable eradication of β-hemolytic streptococci is desirable.
DOI: 10.1007/s00405-015-3872-6
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