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Tonsillitis in children: unnecessary laboratory studies and antibiotic use
Antti Kunnamo1, Matti Korppi2, Merja Helminen1
1Pediatric Research Center, Tampere University and Univesity Hospital, Tampere, Finland.
Background:
The Finnish Current Care Guidelines on diagnostics and treatment of sore throat recommend the treatment of only group A streptococcus (GAS) positive cases with penicillin. The aim of the study was to evaluate how these guidelines are followed in the pediatric emergency unit.
Methods:
We analyzed retrospectively the data on microbiological studies and blood tests done, and data on prescribing of antibiotics, of 200 children admitted for febrile exudative tonsillitis.
Results:
After the clinical diagnosis of exudative tonsillitis, antigen test and/or culture for GAS identification was done in >95% of cases. All the 32 (16%) children with GAS infection, but also 52 (38%) of the 137 children without any evidence of bacterial infection received antibiotics. Additional laboratory studies were done in 96% of children. Serum C-reactive concentrations or white blood cell counts were not able to separate streptococcal from non-streptococcal tonsillitis. No serious bacterial infection was diagnosed.
Conclusions:
The Finnish Current Care Guidelines lead to over-treatment with antibiotics. None of the 200 children returned after discharge, suggesting that undertreatment did not happen.
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