This infection may involve the pharynx only and vary from mild to severe, or it may involve both tonsils and pharynx. It is uncommon under age 2 or over age 40.
Typical clinical features:

abrupt onset sore throat
severe pain
extreme difficulty in swallowing
pain on talking
foul-smelling breath
constitutional symptoms
- fever ≥ 38°C
- toxicity

Examination

Pharynx very inflamed and oedematous. Tonsils swollen with pockets of yellow exudate on surfaces and Very tender enlarged tonsillar lymph nodes.

Treatment

It should be treated with penicillin or an alternative antibiotic Antibiotic treatment has a variable effect on the resolution of symptoms. It does not protect against glomerulonephritis but does protect against rheumatic fever. Amoxycillin should be avoided in tonsillitis because of confusion caused should mononucleosis be present.
Table 65.3 Treatment for streptococcal throat (proven or suspected)


Children
	phenoxymethyl penicillin 50 mg/kg/day (o) in 2 divided doses for 10 days (to maximum 1 g/day) or erythromycin 50 mg/kg/day (o) in 3 divided doses for 10 days (to maximum 1 g/day) or roxithromycin 150 mg (o) bd for 10 days (if > 40 kg)
Adults
	phenoxymethyl penicillin 500 mg (o) 12 hourly for 10 days (can initiate treatment with one injection of procaine penicillin) or erythromycin 500 mg (o) 12 hourly for 10 days or roxithromycin 300 mg (o) daily for 10 days
In severe cases:
	procaine penicillin 1-1.5 mg IM daily for 3-5 days plus phenoxymethyl penicillin (as above) for 10 days

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