Streptococcal tonsillopharyngitis – principles of diagnosis and treatment

Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
Correspondence: Marcin Dziekiewicz, MD, PhD, Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Żwirki i Wigury 63 A, 02-091 Warsaw, tel.: +48 22 317 94 51, e-mail:

Pediatr Med Rodz 2016, 12 (2), p. 141–149
DOI: 10.15557/PiMR.2016.0013

Tonsillopharyngitis is one of the main causes of medical appointments. In fact, a seemingly simple diagnosis and treatment causes various problems and is the reason of many problems and errors, including antibiotic misuse or overuse. The most frequent aetiological agents of pharyngitis relate to viruses. A carefully taken medical history and physical examination can help distinguish patients in whom bacterial (streptococcal) aetiology should be suspected. However, signs and symptoms themselves do not usually allow the correct diagnosis to be established. A clinical suspicion of bacterial infection must be confirmed microbiologically. The best practice is a throat culture. Rapid tests for the presence of Streptococcus pyogenes antigen are a convenient alternative. They are characterised by high sensitivity and specificity. The first-line treatment in streptococcal tonsillopharyngitis is phenoxymethylpenicillin used for 10 days. Streptococcus pyogenes is uniformly sensitive to this antibiotic. Cefadroxil is reserved for patients with non-immediate hypersensitivity to penicillin and Streptococcus pyogenes carriers. Macrolides, in turn, should be used only if immediate hypersensitivity occurs. In this case, 3–5-day treatment with azithromycin is a convenient alternative to clarithromycin. It is important to use its high, double doses – the standard dose is ineffective. Treatment of streptococcal tonsillopharyngitis with amoxicillin, amoxicillin with clavulanic acid and cefuroxime axetil is considered inappropriate and harmful. These are relatively broad-spectrum antibiotics, but their overuse is conductive to the spread of pneumococci of reduced penicillin sensitivity.

Keywords: Streptococcus pyogenes, pharyngitis, penicillin