Sore throat and tonsillitis
EBM Guidelines
Aug 22, 2024 • Completely updated
Table of contents
- Essentials
- Aetiology of tonsillitis
- Clinical examination
- Throat smear
- Organizing the treatment evd
- Drug therapy in streptococcal tonsillitis evd
- Differential diagnosis and other causes of sore throat
- Recurrent tonsillitis
- Indications for a consultation concerning tonsillectomy evd
- Streptococcal epidemics
- References
Extract
- Acute pharyngitis is usually a mild and self-limited disease caused in most cases by some virus – this should be explained to the patient too.
- A group A streptococci rapid test is the primary option for a patient with throat pain symptoms and a Centor score of 3 or 4 (history of or measured fever exceeding 38 °C, absence of cough, tenderness and swelling of submandibular lymph nodes, tonsillar swelling or exudate). This will make it possible to begin treatment sooner.
- Alternatively (or if symptoms persist), throat culture (streptococcal culture) should be performed, which will also detect group C and G streptococci. A comprehensive throat culture may be necessary to detect pathogens other than streptococci, in case of an atypical clinical picture, in particular.
- Antimicrobials are indicated in symptomatic infections caused by group A streptococci. Pharyngitis with high fever and severe symptoms caused by C or G streptococci should also be treated with antimicrobials.
- Peritonsillitis and a peritonsillar abscess Peritonsillitis and peritonsillar abscess1 should be identified and treated as emergency.
- In recurrent tonsillitis, tonsillectomy is considered if an antimicrobial trial with a first-generation cephalosporin or clindamycin does not help and there are acute infections at least 3 times within 6 months or 4 times within a year.
- Epidemics should be recognized and their spread prevented by giving antimicrobial treatment also to asymptomatic carriers (even when caused by group C or G streptococci).
- In differential diagnostics, epiglottitis Epiglottitis and supraglottitis in an adult2, supraglottitis, laryngitis Hoarseness and dysphonia3, peritonsillar abscess Peritonsillitis and peritonsillar abscess1 and peritonsillitis should be kept in mind.
Linked evidence summaries
- Penicillin is probably as effective as cephalosporins and macrolides in group A streptococcal pharyngitis in adults, but cephalosporins may be more effective than penicillin for preventing a relapse.C↑↑
- Corticosteroids, paracetamol and NSAIDS appear to be effective short-term (less than 24 hours) treatments for sore throat. Longer-term (more than 24 hours) effective treatments include paracetamol and NSAIDS.B
Search terms
Abscess, Analgesics, Cefadroxil, Cephalexin, Child, Clindamycin, Gonorrhea, Infectious Mononucleosis, Infectious diseases, J02*, J03*, J36*, Otorhinolaryngology, Paediatrics, Penicillin V, Peritonsillar Abscess, R07.0, Streptococcus, Streptococcus pyogenes, Tonsil, Tonsillectomy, Tonsillitis, Trismus, antimicrobial therapy, arcanobacter, immediate test, penicillin allergy, recurrent tonsillitis, sore throat, streptococcal disease outbreak, throat bacterial culture