This protocol applies when acute tonsillitis in a child aged 3–14 years is caused by, or highly suspected to involve, β-haemolytic streptococci (group A, C, or G) — indicated by a McIsaac score of at least 3 — and standard treatment cannot be used because of a documented penicillin allergy or incompatibility.

Clinical scenario

Antibiotic therapy is indicated only when β-haemolytic streptococcal infection (group A, C, or G) is highly suspected or proven. Here, the patient is a child aged 3–14 years with a McIsaac score of at least 3 and a penicillin allergy or incompatibility on record — a combination that requires a specific, protocol-defined alternative approach.

Treatment approach

Because penicillin is not an option, the protocol specifies which antibiotic class to use — and which to avoid depending on the nature of the allergy. The complete agent selection, dosing guidance, and sequencing are in the full protocol.

Clinical target: Free of symptoms within 48 hours

References

DOI: 10.1007/s00405-015-3872-6

Antibiotic therapy is indicated only in case of a highly suspected or proven b-hemolytic streptococci infection (of group A, C, or G).
In case of allergy/incompatibility: Age 3–14 years:
Erythromycin-estolate (40 mg/kg/day in three doses for 5 days), or 1st generation cephalosporin (e.g. cefadroxil 50 mg/kg/day in two doses for 5 days)
Another alternative is clindamycin (20 mg/kg body weight/day in three single doses).
In cases of allergies (acute type) against beta-lactam antibiotics, cephalosporins should not be applied because of frequent cross reactions.
With adequate therapy, most of the patients, especially adolescents and adults, are free of symptoms within 48 h.

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Treatment of Acute Tonsillitis with Penicillin Allergy in Children Aged 3–14 (McIsaac Score ≥3, β-Haemolytic Streptococci)

References