⚠ Evidence warning: Clinical trials or other evidence do not support the often-quoted figure that tonsil and adenoid surgery cures sleep apnea in 70-90% of children. This page keeps it as a report of what people, websites or other media say.

Tonsillitis

Throat lozenges, used for brief relief of sore throat pain
Throat lozenges, used for brief relief of sore throat pain

Table of Contents

  1. Overview
  2. Epidemiology
  3. Pathophysiology
  4. Etiology and Risk Factors
  5. Clinical Presentation
  6. Diagnosis
  7. Treatment
  8. Complications
  9. Prognosis
  10. Prevention
  11. Key Research Papers
  12. Featured Videos

1. Overview

Tonsillitis is inflammation of the palatine tonsils — paired lymphoid organs located at the lateral walls of the oropharynx — most commonly caused by viral or bacterial infection. The tonsils form part of Waldeyer's tonsillar ring, a protective lymphoid collar that encircles the upper aerodigestive tract and constitutes the first organized immunological barrier against inhaled and ingested pathogens. When overwhelmed by infection, these tissues become acutely inflamed, enlarged, and painful, producing the characteristic syndrome of sore throat, dysphagia, fever, and cervical lymphadenopathy.

Tonsillitis is one of the most common conditions in primary care and pediatric medicine worldwide. In clinical practice it is often grouped under the broader term pharyngotonsillitis (or simply pharyngitis) when the pharyngeal mucosa is simultaneously involved, which is the norm. The etiological distinction between viral and bacterial tonsillitis is clinically important because Group A Streptococcus (GAS) — the dominant bacterial pathogen, responsible for 5-15% of sore throat visits in adults and 20-30% in children according to the 2012 Infectious Diseases Society of America guideline — requires antibiotic treatment to prevent serious non-suppurative complications including acute rheumatic fever and post-streptococcal glomerulonephritis. The United States Centers for Disease Control and Prevention states that viruses are the most common cause of pharyngitis in all age groups; viral causes do not benefit from antibiotics.

Tonsillitis is classified by temporal pattern:

Management spans from watchful waiting and symptomatic care in uncomplicated viral cases to targeted antibiotic therapy for group A Streptococcus, and surgical tonsillectomy for recurrent or obstructive disease. Understanding the diagnostic criteria, antibiotic stewardship principles, and surgical indications is essential for optimal care.

Back to Table of Contents

2. Epidemiology

Tonsillitis and pharyngitis together account for approximately 15 million physician office visits per year in the United States. The condition is most prevalent in school-age children, with the peak incidence between 5 and 15 years of age. Group A Streptococcus pharyngotonsillitis is responsible for 20-30% of pharyngitis cases in children and 5-15% in adults presenting to clinical settings. Adults generally have lower rates of streptococcal infection, partly because of accumulated immunity after repeated childhood exposures.

Globally, group A Streptococcus infections remain a major public health burden. The World Health Organization estimates that group A Streptococcus causes over 600 million cases of pharyngitis annually worldwide. The burden of disease is disproportionately high in low- and middle-income countries, where inadequate access to antibiotics and healthcare allows uncomplicated group A Streptococcus pharyngitis to progress to acute rheumatic fever (ARF) and ultimately rheumatic heart disease (RHD), a major cause of cardiovascular morbidity and death in young people in sub-Saharan Africa, Southeast Asia, and the Pacific.

In the United States, ARF has become uncommon (incidence <0.5 per 100,000 per year) due to widespread antibiotic access and improving socioeconomic conditions. However, outbreaks of virulent group A Streptococcus strains capable of causing ARF still occur episodically. Tonsillectomy is one of the most frequently performed surgical procedures in the United States, with approximately 289,000 ambulatory procedures per year in children under 15, the figure given in the 2019 tonsillectomy guideline. The annual cost of tonsillitis-related care exceeds $700 million in the US alone.

Seasonality is notable: group A Streptococcus pharyngotonsillitis peaks in late winter and spring (January through May in the Northern Hemisphere) and is transmitted by respiratory droplets and direct contact with infected secretions. Crowded environments — schools, daycare centers, military barracks — facilitate spread. The incubation period is 2-5 days.

Back to Table of Contents

3. Pathophysiology

Tonsillar Immunology

The palatine tonsils are specialized secondary lymphoid organs covered by a stratified squamous epithelium that invaginates to form deep crypts, dramatically increasing the surface area available for antigen sampling. The tonsillar crypts trap inhaled and ingested antigens and microorganisms, which are then processed by the underlying lymphoid tissue containing germinal centers with B lymphocytes, T cell zones with helper and cytotoxic T cells, macrophages, and dendritic cells. This architecture makes the tonsils highly efficient at initiating both humoral and cell-mediated immune responses against mucosal pathogens.

Viral Tonsillitis

Viral pathogens — most commonly adenovirus, rhinovirus, coronavirus, Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV) — infect tonsillar epithelial and lymphoid cells directly, triggering innate immune responses. Pattern recognition receptors (Toll-like receptors, RIG-I) detect viral nucleic acids and activate NF-κB and interferon regulatory factor pathways, inducing production of pro-inflammatory cytokines (interleukin-1 beta (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α) and type I interferons. The resulting tissue inflammation causes vascular dilation, edema, neutrophil infiltration, and the characteristic erythema and swelling of the tonsils. Epstein-Barr virus, which infects B lymphocytes via the CD21 receptor, causes marked lymphocyte proliferation and the extensive tonsillar and systemic lymphadenopathy that characterizes infectious mononucleosis.

Bacterial Tonsillitis (Group A Streptococcus)

Streptococcus pyogenes (Group A Streptococcus) is the most clinically important bacterial cause of tonsillitis. Group A Streptococcus colonizes the pharyngeal mucosa using a surface protein called M protein, which is the dominant virulence factor and provides resistance to phagocytosis by inhibiting complement deposition. Group A Streptococcus produces numerous toxins and enzymes that facilitate tissue invasion and immune evasion:

The inflammatory response to group A Streptococcus produces intense tonsillar edema and exudate formation. A critical pathophysiological mechanism involves molecular mimicry: antibodies produced against the group A Streptococcus M protein cross-react with human cardiac proteins (myosin, tropomyosin, laminin) in genetically susceptible individuals, causing the carditis of acute rheumatic fever. This explains why complete eradication of group A Streptococcus with a full antibiotic course — even in mild or resolving cases — is essential to prevent rheumatic fever.

Back to Table of Contents

4. Etiology and Risk Factors

Viral Causes (the Most Common Cause at All Ages)

Bacterial Causes (Group A Streptococcus: 5-15% of Adult and 20-30% of Child Visits)

Risk Factors

Back to Table of Contents

5. Clinical Presentation

Acute Viral Tonsillitis

Viral pharyngotonsillitis typically presents with gradual onset of sore throat accompanied by rhinorrhea, nasal congestion, cough, hoarseness, and low-grade fever. The tonsils appear erythematous and edematous but exudate is less common than in bacterial disease (though adenovirus can produce a striking exudative tonsillitis). Oral ulcers and vesicles suggest herpetic or coxsackievirus etiology. Infectious mononucleosis due to Epstein-Barr virus produces the most severe viral tonsillitis: markedly enlarged, edematous, exudative tonsils (sometimes meeting in the midline — "kissing tonsils"), diffuse bilateral cervical lymphadenopathy, splenomegaly (in 50% of cases), hepatomegaly, and a characteristic peripheral blood smear showing >10% atypical lymphocytes. Airway obstruction can occur with very large Epstein-Barr virus tonsils.

Acute Bacterial Tonsillitis (Group A Streptococcus)

Group A Streptococcus pharyngotonsillitis classically presents with abrupt onset of severe sore throat, odynophagia, fever >38.3°C (101°F), and marked tonsillar enlargement with erythema. The presence of tonsillar exudate (white or gray patches of purulent material on the tonsil surface), tender anterior cervical lymphadenopathy, and the absence of cough are the cardinal features distinguishing group A Streptococcus from viral pharyngitis. Constitutional symptoms include headache, malaise, myalgia, and anorexia. In young children, group A Streptococcus may present with abdominal pain, nausea, and vomiting rather than classic throat symptoms. When group A Streptococcus secretes pyrogenic exotoxins, a diffuse scarlatiniform rash (fine, sandpaper-textured erythema sparing the face but creating a perioral pallor) and strawberry tongue develop, defining scarlet fever — a presentation of group A Streptococcus pharyngitis rather than a separate disease.

Peritonsillar Abscess (PTA)

Peritonsillar abscess is the most common deep space neck infection and represents suppurative spread of tonsillitis into the peritonsillar space (between the tonsillar capsule and the superior constrictor muscle). It presents with progressive unilateral throat pain, a characteristic "hot potato voice" (muffled, potato-in-mouth speech quality from palatal and peritonsillar swelling), trismus (difficulty opening the mouth due to pterygoid muscle spasm), drooling, and uvular deviation away from the affected side. The affected tonsil is displaced medially and inferiorly, and the soft palate is bulging and erythematous. High fever and systemic toxicity are common.

Chronic and Recurrent Tonsillitis

Recurrent acute tonsillitis produces repeated episodes of sore throat with the features described above. Between episodes, patients may be entirely asymptomatic. Chronic tonsillitis manifests as persistent sore throat, halitosis, and tonsilloliths (white or yellow calcified debris lodged in the crypts, visible on examination). The tonsils may appear scarred and irregular without frank enlargement. Tonsillar hypertrophy — physical enlargement of the tonsils even without acute infection — can cause obstructive sleep apnea (OSA), snoring, dysphagia, and muffled voice, particularly in children. Grading of tonsillar size uses the Brodsky scale: Grade 1 (tonsils within the pillars), Grade 2 (tonsils extending to but not reaching the midline), Grade 3 (tonsils extending 50-75% toward the midline), Grade 4 (tonsils meeting or nearly meeting in the midline, "kissing tonsils").

Back to Table of Contents

6. Diagnosis

The Centor Criteria

The Centor score is the most widely used clinical decision tool to estimate the probability of group A Streptococcus pharyngotonsillitis and guide diagnostic testing and empiric treatment. The original four Centor criteria are:

  1. Tonsillar exudate — visible white or gray patches on the tonsil surface (1 point)
  2. Tender anterior cervical lymphadenopathy — swollen, painful lymph nodes in the anterior cervical chain (1 point)
  3. Fever history >38°C (100.4°F) — documented or reported fever (1 point)
  4. Absence of cough — cough is a feature of viral (particularly adenoviral) pharyngitis and makes group A Streptococcus less likely (1 point)

Score interpretation: 0-1 points — group A Streptococcus probability <10%, a level at which scoring guidance commonly lists no testing or antibiotics (the 2012 Infectious Diseases Society of America guideline says scoring systems help identify patients at such low risk that a culture or rapid test is usually unnecessary, and the German guideline ties testing to a score of 3 or more); 2-3 points — group A Streptococcus probability 15-35%, where the usual pathway is a rapid antigen detection test (RADT) with treatment if positive; 4 points — group A Streptococcus probability 40-60%, where the options listed are empiric treatment or testing first.

McIsaac Modification

The McIsaac score adds an age adjustment to improve specificity in adults: subtract 1 point for age ≥45 years, add 1 point for age 3-14 years. This modification reduces unnecessary antibiotic prescribing in low-risk adults and improves overall diagnostic accuracy across age groups. A modified score ≤1 has a negative predictive value of approximately 90-95% for group A Streptococcus, making testing and treatment unnecessary.

Rapid Antigen Detection Test (RADT)

The RADT (rapid strep test) detects group A Streptococcus cell wall carbohydrate antigen from a throat swab within 5-10 minutes at the point of care. Performance characteristics:

Throat Culture

A throat swab culture on sheep blood agar remains the gold standard for group A Streptococcus diagnosis, with sensitivity of 90-95% and specificity of 99%. Results require 24-48 hours to finalize. The swab needs to contact both tonsils and the posterior pharynx to maximize sensitivity. Culture also allows antimicrobial susceptibility testing, which is increasingly relevant given rising macrolide resistance in group A Streptococcus.

Laboratory and Imaging Studies

Back to Table of Contents

7. Treatment

Supportive Care (All Cases)

Symptomatic relief is the cornerstone of management for viral tonsillitis and an important adjunct in bacterial cases:

Antibiotic Therapy for Group A Streptococcus

Antibiotic treatment of confirmed or highly probable group A Streptococcus pharyngotonsillitis achieves four important goals: shortening illness, preventing suppurative complications (peritonsillar abscess, retropharyngeal abscess), reducing contagiousness (the Centers for Disease Control and Prevention states that an appropriate antibiotic "for 12 hours or longer limits a person's ability to transmit" the bacteria), and most critically, preventing acute rheumatic fever (requires eradication of group A Streptococcus from the pharynx; the Infectious Diseases Society of America guideline lists a 10-day course of penicillin).

A 2021 Cochrane review of antibiotics for all sore throats (29 trials, 15,337 cases, few of which separated bacterial from viral causes) shows the size of these effects. Without antibiotics, 82% of people were symptom-free by one week. Antibiotics cut sore throat at day 3 (risk ratio 0.70) and reduced quinsy, a peritonsillar abscess (Peto odds ratio 0.16), and acute rheumatic fever (Peto odds ratio 0.36), but did not significantly reduce fever at day 3. Most of the trials date from the 1950s, when rheumatic fever was much more common than today.

First-line regimens (per the 2012 Infectious Diseases Society of America guidelines):

Penicillin allergy:

Peritonsillar Abscess Treatment

Peritonsillar abscess requires drainage plus antibiotic therapy:

Surgical Treatment: Tonsillectomy

Tonsillectomy remains one of the most common operations in the United States and globally. The decision to proceed is based on carefully defined indications balancing surgical benefit against operative risks.

Paradise criteria for recurrent tonsillitis (the evidence-based standard):

Additional indications for tonsillectomy:

Surgical techniques include traditional cold-steel dissection, electrocautery, and newer modalities (coblation, laser, microdebrider). Intracapsular tonsillectomy (tonsillotomy) — partial removal leaving the tonsillar capsule intact — is gaining favor for OSA in children because it reduces post-operative pain and bleeding risk compared to total tonsillectomy, though it carries a small risk of tonsillar regrowth. Post-tonsillectomy hemorrhage is the most feared complication, occurring in 2-5% of patients (primary within 24 hours, secondary on days 5-10 when the eschar separates).

Adults: the NATTINA trial (2023, 27 United Kingdom hospitals, 453 people aged 16 or older with recurrent acute tonsillitis) compared immediate tonsillectomy with non-surgical care over 24 months. Sore throat days were fewer with surgery (median 23 vs 30 days; adjusted incident rate ratio 0.53, 95% confidence interval 0.43-0.65). Adverse events related to surgery occurred in 39% of operated participants, and bleeding in 19%.

Care around the operation in children: the 2019 tonsillectomy guideline states that codeine must not be given after tonsillectomy to children younger than 12, that antibiotics are not to be given around the operation, and that ibuprofen, acetaminophen, or both are the recommended pain control. It also calls for a single dose of intravenous dexamethasone during surgery and for overnight hospital monitoring of children under 3 or with severe obstructive sleep apnea.

Back to Table of Contents

8. Complications

Suppurative (Infectious) Complications

Peritonsillar Abscess

Peritonsillar abscess (PTA) is the most common deep space infection of the head and neck, accounting for approximately 45,000 emergency department visits per year in the United States. PTA develops when tonsillitis spreads beyond the tonsillar capsule into the peritonsillar space, where pus accumulates between the superior constrictor muscle and the tonsil. It is a polymicrobial infection involving group A Streptococcus together with anaerobes (Fusobacterium, Prevotella, Peptostreptococcus) that colonize the tonsillar crypts. The classic presentation — "hot potato" muffled voice, trismus, uvular deviation, and drooling — is distinct and usually diagnostic. Rare but serious complications of untreated PTA include spread to the retropharyngeal space, parapharyngeal space, or the deep spaces of the neck, potentially causing necrotizing fasciitis, mediastinitis, and life-threatening airway obstruction.

Retropharyngeal and Parapharyngeal Space Infections

More serious deep neck space infections can arise from direct extension of tonsillar or peritonsillar infection. Retropharyngeal abscess is most common in children under 6 (due to retropharyngeal lymph nodes that involute with age) and presents with stiff neck, drooling, and muffled cry. Ludwig's angina (cellulitis of the floor of the mouth) and descending necrotizing mediastinitis are life-threatening complications requiring emergent surgical drainage and aggressive intravenous antibiotics.

Lemierre's Syndrome

Lemierre's syndrome (postanginal septicemia) is a rare but potentially fatal complication, most commonly occurring in previously healthy adolescents and young adults. It is caused by Fusobacterium necrophorum spreading from the pharynx to the internal jugular vein, causing septic thrombophlebitis and subsequent septic emboli to the lungs, liver, joints, and other organs. Classic presentation: severe sore throat followed by high fever, rigors, and pleuritic chest pain within 1-3 weeks. Treatment requires prolonged intravenous antibiotics (metronidazole plus a beta-lactam) and often anticoagulation.

Acute Rheumatic Fever (ARF)

Acute rheumatic fever is the most important non-suppurative complication of group A Streptococcus pharyngotonsillitis, occurring in 0.3-3% of untreated group A Streptococcus pharyngitis cases (higher during epidemic strains). ARF is a delayed, immune-mediated, multi-system inflammatory disease that develops 2-4 weeks after group A Streptococcus pharyngitis through antibody cross-reactivity with cardiac, joint, and neural tissues (molecular mimicry). The Jones criteria for ARF diagnosis require evidence of prior group A Streptococcus infection plus either two major criteria or one major and two minor criteria. Major criteria include: carditis (the most serious manifestation — pancarditis with mitral and aortic valve damage in 40-60% of ARF cases), migratory polyarthritis (large joints, most common major criterion, 75% of cases), Sydenham's chorea (involuntary jerky movements, emotional lability), subcutaneous nodules, and erythema marginatum (skin rash). Repeated ARF episodes cause cumulative valve damage, ultimately leading to rheumatic heart disease (RHD) — the most common cause of acquired heart disease in people under 25 worldwide. A complete 10-day antibiotic course eliminates group A Streptococcus and effectively prevents ARF even when started up to 9 days into the illness.

Post-Streptococcal Glomerulonephritis (PSGN)

PSGN is an immune complex-mediated nephritis caused by specific nephritogenic strains of group A Streptococcus, occurring 1-3 weeks after pharyngeal group A Streptococcus infection. It presents with hematuria (tea-colored urine), proteinuria, edema, and hypertension. Unlike ARF, antibiotic treatment of the precipitating group A Streptococcus infection does not reliably prevent PSGN. In children, PSGN is usually self-limiting and resolves completely; in adults, chronic renal impairment may occur in a minority.

Obstructive Sleep Apnea (OSA)

Chronic tonsillar hypertrophy — particularly in children aged 2-8 who have physiologically large tonsils relative to airway size — is the leading cause of pediatric obstructive sleep apnea. OSA secondary to tonsillar hypertrophy causes fragmented sleep, nocturnal hypoxemia, and a range of neurobehavioral sequelae including inattention, hyperactivity, poor school performance, and behavioral problems that can closely mimic attention-deficit/hyperactivity disorder (ADHD). Severe untreated pediatric OSA causes failure to thrive, pulmonary hypertension, and cor pulmonale in rare cases. Tonsillectomy with adenoidectomy (T&A) is often quoted as curative for OSA in approximately 70-90% of children; the 578-child review above measured complete resolution in 27.2%, and the 2019 guideline says sleep-disordered breathing may persist or recur after surgery. It is the most common indication for tonsillectomy in developed countries today.

Back to Table of Contents

9. Prognosis

The vast majority of tonsillitis episodes — both viral and bacterial — resolve completely without complications. Viral pharyngotonsillitis is self-limiting in 7-10 days in immunocompetent individuals. Epstein-Barr virus mononucleosis typically resolves over 2-4 weeks, though fatigue may persist for several months in a minority of patients; splenic rupture is the reason contact sports are commonly put off for 3-4 weeks after diagnosis. HSV primary tonsillitis resolves in 10-14 days and rarely requires antiviral therapy in healthy individuals.

Group A Streptococcus pharyngotonsillitis treated with a complete penicillin or amoxicillin course has an excellent prognosis: fever typically resolves within 24-48 hours of starting antibiotics, sore throat improves significantly within 48-72 hours, and an appropriate antibiotic for 12 hours or longer limits the ability to pass the bacteria on. The Centers for Disease Control and Prevention lists staying home from work, school, or daycare until afebrile and at least 12-24 hours after starting antibiotics; it notes that children return when well appearing and at least 12 hours after starting, with at least 24 hours considered in settings such as an outbreak. Treatment failure (persistent group A Streptococcus carriage despite antibiotics) occurs in approximately 10-15% of cases; retreatment with amoxicillin-clavulanate or clindamycin (which have activity against beta-lactamase-producing oral flora that can inactivate penicillin) is usually successful.

The prognosis of recurrent tonsillitis depends on whether surgical intervention is pursued. Children meeting the Paradise criteria who undergo tonsillectomy experience a reduction in throat infections, which Paradise's trials in severely affected children followed for at least 2 years. A 2014 Cochrane review pooling five trials in severely and less severely affected children found an average of 3 sore throat episodes in the year after surgery, one of them the predictable episode right after the operation, against 3.6 without surgery (a difference of 0.6 episodes), and moderate or severe episodes in severely affected children of 1.1 vs 1.2, not a significant difference. The review calls the effect "very modest" and has good information only for the first year, with progressive convergence described in subsequent years as children naturally outgrow the tendency to recurrent tonsillitis. Children with less severe recurrence (below Paradise threshold) show smaller benefit from tonsillectomy: in Paradise's 2002 trials of moderately affected children, controls had only 0.16 to 0.43 moderate or severe episodes a year, 7.9% of operated children had a surgical complication, and the authors concluded the modest benefit "seems not to justify" the risks, morbidity, and cost. The 2012 Infectious Diseases Society of America guideline states "we do not recommend tonsillectomy solely to reduce the frequency of GAS pharyngitis (strong, high)," and the 2019 tonsillectomy guideline strongly recommends watchful waiting below the Paradise thresholds. The risk of post-tonsillectomy hemorrhage requiring operative intervention is approximately 1-3%, with higher rates in adults than children.

With proper antibiotic treatment, acute rheumatic fever is essentially preventable. Among patients with documented ARF, approximately 50-60% develop some degree of valvular disease over time without secondary prophylaxis; with long-term penicillin secondary prophylaxis (benzathine penicillin G injections every 3-4 weeks, for the durations listed under Prevention), progression to severe RHD is substantially reduced.

Back to Table of Contents

10. Prevention

Primary Prevention of Group A Streptococcus Pharyngitis

Secondary Prevention of Rheumatic Fever

Patients who have had a documented episode of acute rheumatic fever are at markedly increased risk of recurrent ARF and progressive cardiac damage with subsequent group A Streptococcus pharyngitis. The 2009 American Heart Association statement says such a person "needs continuous antimicrobial prophylaxis" to prevent recurrences (long-term secondary antibiotic prophylaxis):

Early, silent rheumatic heart disease found by ultrasound is a separate setting. In a Ugandan trial of 818 children and adolescents aged 5 to 17, penicillin injections every 4 weeks for 2 years were followed by progression in 0.8%, compared with 8.2% without prophylaxis. The authors state that more research is needed before population-wide screening can be recommended.

Antibiotic Stewardship

Given that viruses are the most common cause of pharyngotonsillitis and viral illness does not require antibiotics, antibiotic stewardship is a critical aspect of tonsillitis management. Broad antibiotic prescribing for undifferentiated sore throat contributes to antimicrobial resistance, particularly macrolide resistance in group A Streptococcus, and exposes patients to unnecessary side effects (diarrhea, allergic reactions, Clostridioides difficile colitis). The systematic application of Centor/McIsaac scoring and RADT testing — rather than empiric antibiotic prescribing for all sore throats — is the central strategy for appropriate antibiotic use.

Immune Support

Back to Table of Contents

Key Research Papers

Clinical Practice Guidelines

  1. Shulman ST et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-102. — PubMed PMID: 22965026
  2. Windfuhr JP et al. Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol. 2016;273(4):973-987. — PubMed PMID: 26755048
  3. Mitchell RB et al. Clinical Practice Guideline: Tonsillectomy in Children (Update). Otolaryngol Head Neck Surg. 2019;160(1_suppl):S1-S42. — PubMed PMID: 30798778
  4. Centers for Disease Control and Prevention. Clinical Guidance for Group A Streptococcal Pharyngitis. — cdc.gov clinical guidance

Tonsillectomy and Surgical Outcomes

  1. Paradise JL et al. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002;110(1 Pt 1):7-15. — PubMed PMID: 12093941
  2. Paradise JL et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984;310(11):674-683. — PubMed PMID: 6700642
  3. Burton MJ, Glasziou PP, Chong LY, Venekamp RP. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2014;(11):CD001802. — PubMed PMID: 25407135
  4. Wilson JA et al. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. Lancet. 2023;401(10393):2051-2059. — PubMed PMID: 37209706
  5. Bhattacharjee R et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676-683. — PubMed PMID: 20448096

Streptococcal Pharyngitis and Rheumatic Fever

  1. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5(11):685-694. — PubMed PMID: 16253886
  2. Gerber MA, Baltimore RS, Eaton CB, et al. Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee. Circulation. 2009;119(11):1541-1551. — PubMed PMID: 19246689
  3. de Loizaga SR et al. Rheumatic Heart Disease in the United States: Forgotten But Not Gone: Results of a 10 Year Multicenter Review. J Am Heart Assoc. 2021;10(16):e020992. — PubMed PMID: 34348475
  4. Al-Jazairi A, Al-Jaser R, Al-Halees Z, Shahid M, Al-Jufan M, Al-Mayouf S, Al-Rajhi A, Al-Hajjar S. Guidelines for the secondary prevention of rheumatic heart disease: Endorsed by Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med. 2017;4(1):47-50. — PubMed PMID: 30805500
  5. Beaton A et al. Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease. N Engl J Med. 2022;386(3):230-240. — PubMed PMID: 34767321

Diagnostic Accuracy and Clinical Scores

  1. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998;158(1):75-83. — PubMed PMID: 9475915
  2. Cohen JF et al. Rapid antigen detection test for group A streptococcus in children with pharyngitis. Cochrane Database Syst Rev. 2016;7:CD010502. — PubMed PMID: 27374000

Treatment Efficacy

  1. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2021;12:CD000023. — PubMed PMID: 34881426
  2. Hayward G et al. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2012;10:CD008268. — PubMed PMID: 23076943
  3. de Cassan S, Thompson MJ, Perera R, Glasziou PP, Del Mar CB, Heneghan CJ, Hayward G. Corticosteroids as standalone or add-on treatment for sore throat. Cochrane Database Syst Rev. 2020;5:CD008268. — PubMed PMID: 32356360
  4. Skoog Ståhlgren G, Tyrstrup M, Edlund C, Giske CG, Mölstad S, Norman C, Rystedt K, Sundvall PD, Hedin K. Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. BMJ. 2019;367:l5337. — PubMed PMID: 31585944
  5. Chovel-Sella A, Ben Tov A, Lahav E, Mor O, Rudich H, Paret G, Reif S. Incidence of rash after amoxicillin treatment in children with infectious mononucleosis. Pediatrics. 2013;131(5):e1424-e1427. — PubMed PMID: 23589810

PubMed Topic Searches

  1. PubMed: Group A streptococcus pharyngitis treatment
  2. PubMed: Tonsillectomy indications Paradise criteria
  3. PubMed: Peritonsillar abscess drainage management
  4. PubMed: Acute rheumatic fever streptococcal prevention
  5. PubMed: Centor score streptococcal pharyngitis diagnosis
  6. PubMed: Tonsillitis pediatric sleep apnea tonsillectomy
  7. PubMed: Rapid antigen detection strep throat accuracy
  8. PubMed: Fusobacterium necrophorum Lemierre syndrome
  9. PubMed: EBV infectious mononucleosis tonsillitis
  10. PubMed: Amoxicillin penicillin streptococcal pharyngitis 10 days

Back to Table of Contents

Connections

Back to Table of Contents