Antibiotics for tonsillitis: should the emergency department emulate general practice?

Area of Science:

• Emergency Medicine
• Infectious Diseases
• Clinical Pharmacology

Background:

• Acute tonsillitis is a common condition managed in emergency departments.
• Antibiotic prescribing guidelines, such as the Centor criteria, aim to optimize treatment and reduce antimicrobial resistance.
• Appropriate antibiotic use in acute tonsillitis remains a challenge in emergency care.

Purpose of the Study:

• To evaluate the appropriateness of antibiotic prescribing for acute tonsillitis in an emergency department (ED).
• To assess the utilization of the Centor score in guiding antibiotic decisions for acute tonsillitis in the ED.
• To identify patterns of antibiotic use and throat swab cultures in this patient population.

Main Methods:

• A cross-sectional observational study was conducted in a London district general hospital.
• Medical records of 273 patients diagnosed with acute tonsillitis in the ED were reviewed.
• Data collected included documented signs/symptoms for Centor score derivation, prescribed antibiotics, and throat swab results.

Main Results:

• The Centor score was not recorded for any patient; however, derived scores indicated inappropriate antibiotic prescription in 80% of cases.
• Broad-spectrum antibiotics were prescribed to 25% of patients.
• Throat swabs were performed in 24% of patients, and antibiotic prescribing was common even in Group A Streptococcus-negative cases.

Conclusions:

• Antibiotic prescribing for acute tonsillitis in the ED was not guided by the Centor score, relying instead on clinical judgment.
• A high rate of inappropriate antibiotic use, particularly broad-spectrum agents, was observed.
• Further research is recommended to implement and assess the Centor score's utility in ED antibiotic stewardship for acute tonsillitis.