Treatment of Acute Tonsillitis with Penicillin Allergy in Beta-Hemolytic Streptococcal Infection

This protocol addresses acute tonsillitis in patients who cannot receive penicillin — a specific clinical situation that calls for a distinct antibiotic strategy when a beta-hemolytic streptococcal cause is confirmed or strongly suspected.

Clinical Scenario

Beta-hemolytic streptococcal infection (group A, C, or G) with a McIsaac score of at least 3, in patients aged 15 years and older, who have a penicillin allergy or incompatibility.

Age ≥ 15 years McIsaac score ≥ 3 Group A / C / G strep Penicillin allergy / incompatibility

✓ Treatment goal: freedom from symptoms within 48 hours.

When penicillin cannot be used, this protocol specifies oral antibiotic alternatives indicated for confirmed or highly suspected beta-hemolytic streptococcal tonsillitis. The complete regimen — including which agents apply and under what conditions — is detailed in the full protocol.

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References

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 15 years and older.

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.

DOI: 10.1007/s00405-015-3872-6

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