Streptococcal Tonsillitis in Adults Not Responding to Penicillin V: What to Do Next

This protocol applies to adults and adolescents aged 15 and older with confirmed or highly suspected β-hemolytic streptococcal tonsillitis (group A, C, or G) and a McIsaac score of at least 3, who have no penicillin allergy but have not responded adequately to first-line Penicillin V treatment.

Clinical scenario

β-hemolytic streptococci infection (group A, C, or G)
McIsaac score of at least 3
Age 15 years and older
No penicillin allergy or incompatibility

Previous treatment — goal not reached

First-line treatment with Penicillin V was insufficient: the expected goal — freedom from symptoms within 48 hours — was not achieved. This protocol defines the next clinical step after that failure.

Next-line approach (partial summary — full regimen in protocol)

In selected situations such as Penicillin V failure, an oral cephalosporin may be considered — but the specific selection criteria, agent choice, and complete regimen are detailed in the full protocol.

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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).

For patients with sore throat in times and regions without epidemic occurrence of b-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 15 years and older:

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 b-hemolytic streptococci is desirable.

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