Medical treatment of non-streptococcal recurrent tonsillitis

Forty patients with a history of recurrent non-beta-hemolytic streptococcal tonsillitis (RNST) participated in a prospective randomized study comparing penicillin and clindamycin in the treatment of acute non-group A streptococcal infection. The efficiency of each antibiotic was evaluated according to its ability to alleviate acute infection and prevent recurrence. Surface tonsillar cultures were obtained both before and ten days after the termination of therapy, and specimens were processed for aerobic and anaerobic bacteria. Beta-lactamase-producing bacteria (BLPB) were present in 36 (90%) tonsillar cultures. Thirty-one BLPB were isolated in 17 patients before penicillin therapy and 42 BLPB were recovered from 19 after such treatment. Thirty-three BLPB were recovered in 19 patients before clindamycin therapy, after which four BLPB were isolated in three patients (P less than .05). From the second day posttherapy onward, significantly fewer patients who received clindamycin had fever, pharyngeal injection, and sore throat. In a 1-year follow-up period, recurrent tonsillitis was noted in 13 of the patients who received penicillin and in two treated with clindamycin (P less than .001). The data clearly demonstrate the superiority of clindamycin therapy over penicillin in patients with RNST.