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Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review

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Abstract

The purpose was to determine the current evidence for preferable antibiotic treatment in three common clinical situations with insufficient consensus: Q1: Can antibiotic treatment prevent future attacks of acute pharyngo-tonsillitis (APT) in patients with recurrent APT (RAPT)? Q2: Which antibiotic regimen is preferable in the treatment of APT in patients with RAPT? Q3: Which antibiotic regimen is preferable in the treatment of relapsing APT? Five databases were searched systematically for randomized clinical trials on patients with RAPT with or without current APT or with relapse of APT. Of the unique publications, 643 were found. Five studies addressing Q1 (n = 3) and Q2 (n = 2) met the eligibility criteria. No studies reporting on Q3 were included. Q1: Two studies found that clindamycin and cefpodoxime, respectively, were effective in preventing future APT episodes and in eradicating group A streptococci from the tonsils of RAPT patients. One study found that long-term azithromycin had no effect on the number of APT episodes. Q2: Two studies reported superior clinical and microbiological effects of clindamycin and amoxicillin with clavulanate, respectively, compared to penicillin. The four studies showing superior effects of clindamycin and amoxicillin with clavulanate were assessed to have high risk of bias. Hence, the level of evidence was moderate. There is considerable evidence to suggest that clindamycin and amoxicillin with clavulanate are superior to penicillin with preferable effects on the microbiological flora and the number of future attacks of APT in patients with RAPT. Antibiotic treatment is an option in patients with RAPT, who has contraindications for tonsillectomy.

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Funding

This work was supported by the Lundbeck Foundation (grant number R185–2014-2482).

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Noerrebrogade 44, 8000, Aarhus, Denmark

    Holger Munck, Anders W. Jørgensen & Tejs Ehlers Klug

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  1. Holger Munck
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  2. Anders W. Jørgensen
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  3. Tejs Ehlers Klug
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Correspondence to Holger Munck.

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Appendix

Appendix

Search strategy

The search strategy used in the five major search engines as exemplified in MEDLINE:

  • #1 sore throat OR acute tonsillitis OR acute pharyngitis

  • #2 recurrent OR recurrence OR treatment failure

  • #3 antibiotics OR antibiotic treatment

  • #4 #1 AND #2 AND #3

  • #5 #4 (filter: randomized controlled trial; English)

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Munck, H., Jørgensen, A.W. & Klug, T.E. Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review. Eur J Clin Microbiol Infect Dis 37, 1221–1230 (2018). https://doi.org/10.1007/s10096-018-3245-3

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  • DOI: https://doi.org/10.1007/s10096-018-3245-3

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