Tonsillopharyngitis is the inflammation of the tonsils and pharynx.
Etiologies include bacterial and viral pathogens.
Sore throat is the most common presenting symptom in older children.

Principles of Therapy

Symptomatic treatment - Non group A beta-hemolytic streptococcus (GABHS) infection
  • Symptomatic treatment is important in the management of children with sore throat
Symptomatic treatment - Group A beta-hemolytic streptococcus (GABHS) infection
  • Important in the management of children with sore throat
  • Same as for non-GABHS infection
Antimicrobial therapy
  • Treatment started only for documented GABHS infection
  • Due to practical constraints, antibiotics may be started empirically if:
    • GABHS is clinically suspected
    • Patient is toxic-looking
    • Follow-up is not possible
  • Empiric treatment of GABHS is discouraged due to poor diagnostic accuracy even with elaborate clinical scoring systems
  • A rapid antigen detection test (RADT) or throat swab should be taken before starting empiric antibiotics
  • If antibiotics are started empirically, & culture results are negative, the antibiotic should be discontinued
  • Appropriate antibiotics prevent acute rheumatic fever (ARF), prevent suppurative complications, decrease infectivity & shorten clinical course


Non-group A beta-hemolytic streptococcus (Non-GABHS)

Simple analgesics / antipyretics
  • Paracetamol is the drug of choice for analgesia in sore throat
  • Aspirin is not recommended due to the risk of Reye’s syndrome
Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Ibuprofen is a safe & effective alternative for analgesia & antipyrexia
  • Diclofenac may also be used for against pain caused by acute tonsillopharyngitis (ATP)
  • As NSAIDs are associated with significant risk of gastrointestinal bleeding (GI) bleeding, their routine use is not recommended
Throat lozenges/gargle/spray
  • May be helpful especially in those with significant throat pain or discomfort
Group A beta-hemolytic streptococcus (GABHS)

  • Drug of choice
  • Proven efficacy, narrow spectrum, safety & low cost
  • Full 10-day course of treatment for oral medications
  • Intramuscular (IM) penicillin may be advisable if poor compliance is a concern
  • Better tolerated than Penicillin
  • 2nd line to Penicillin in pediatric patients due to taste preference
  • Eg Erythromycin, Azithromycin
  • May be used for patients with Penicillin allergy
  • Local resistance patterns should be included in the consideration for an alternative antibiotic in Penicillin-allergic patients
    • Resistance rate in Taiwan is approximately 10%
  • Azithromycin or Cephalexin may be used for Erythromycin-intolerant patients
  • Eg Cefaclor, Cefadroxil, Cefdinir, Cefixime, Cefpodoxime, Cephalexin
  • Alternative to Amoxicillin for the eradication of streptococcal infection especially in recurrent cases
  • Studies show that a 5-day treatment with a cephalosporin is superior to a 10-day course with Penicillin
  • May be used for those who are both Penicillin-allergic & Erythromycin-intolerant
    • Resistance rate in Taiwan is approximately 10%
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