Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review

Area of Science:

• Infectious Diseases
• Microbiology
• Clinical Medicine

Background:

• Recurrent acute pharyngo-tonsillitis (RAPT) presents clinical challenges due to insufficient consensus on optimal antibiotic management.
• Identifying effective antibiotic strategies is crucial for preventing future episodes and managing relapses.

Purpose of the Study:

• To evaluate the current evidence for preferable antibiotic treatments in recurrent acute pharyngo-tonsillitis (RAPT).
• To determine if antibiotic therapy can prevent future APT attacks in RAPT patients.
• To compare the efficacy of different antibiotic regimens for APT in RAPT patients and for relapsing APT.

Main Methods:

• Systematic review of randomized clinical trials across five databases.
• Searched for studies on RAPT patients with or without current APT or with relapse.
• Included studies addressing prevention of future APT attacks and preferred antibiotic regimens for APT in RAPT.

Main Results:

• Clindamycin and cefpodoxime showed effectiveness in preventing future APT episodes and eradicating Group A Streptococcus.
• Long-term azithromycin did not significantly reduce the number of APT episodes.
• Clindamycin and amoxicillin with clavulanate demonstrated superior clinical and microbiological effects compared to penicillin, though with a high risk of bias in some studies.

Conclusions:

• Antibiotic treatment, particularly with clindamycin and amoxicillin with clavulanate, is a viable option for RAPT patients, especially those with contraindications for tonsillectomy.
• These agents appear superior to penicillin for managing RAPT, potentially reducing future attacks and improving microbiological outcomes.
• Further high-quality research is needed to confirm findings for relapsing APT.