Tonsillitis - Implications of Microbial Interactions On Therapy

Implications of Microbial Interactions On Therapy

Penicillin is recommended by some guidelines as the antibiotic of choice, although other antibiotics are more effective in the bacteriologic and clinical cure of acute and recurrent GABHS tonsillitis. Lincomycin, clindamycin, and amoxicillin-clavulanate are more effective in relapsing GABHS tonsillitis. Cephalosporins are superior to penicillins in both acute and relapsing GABHS tonsillitis. In those who failed penicillin, the goal of therapy is to eradicate the beta-lactamase-producing bacteria that "shield" GABHS from penicillin, while preserving whatever "protective" interfering organisms (i.e., alpha hemolytic streptococci) that may colonize the tonsils. Cephalosporins have been successful in eradicating GABHS better, and in some instances even faster than penicillins. Their efficacy is explained by their activity against beta-lactamase producing aerobic bacteria, and sparing of interfering organisms. Over 35 randomized studies had demonstrated cephalosporins of all generations to have a much higher success rate in eradicating GABHS than penicillin (a third of the failure rate of penicillin), and 12 studies found equal or better success rate in 5 to 7 days of therapy as compared with 10 days of penicillin.