Treatment of Chronic Tonsillitis with β-Haemolytic Streptococcal Infection in Children Aged 3–14 with Penicillin Allergy
Clinical Scenario
This protocol addresses children aged 3 to 14 presenting with chronic tonsillitis in whom β-haemolytic streptococcal infection (group A, C, or G) is highly suspected or confirmed, and who have a known penicillin allergy or incompatibility. A McIsaac score of at least 3 is required to justify antibiotic treatment in this setting.
- β-haemolytic streptococcal infection — group A, C, or G (suspected or confirmed)
- McIsaac score ≥ 3
- Age 3–14 years key criterion
- Penicillin allergy or incompatibility
Treatment Approach
Because penicillin cannot be used, the protocol specifies oral antibiotic alternatives from distinct drug classes suited to this paediatric age group. The appropriate choice among them depends in part on the nature of the penicillin allergy — in particular, whether an acute-type beta-lactam allergy is present, which restricts certain options.
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:
- 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.