Streptococcal tonsillopharyngitis


Streptococcal tonsillopharyngitis


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


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


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) 

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






error: Content is protected !!