COMMON TREATMENT FOR ACUTE TONSILLITIS IN THE COMMUNITY

BACKGROUND: Streptococcal tonsillitis among adults is a common diagnosis. There is wide agreement regarding the recommended treatment, which is Phenoxymethyl Penicillin (Penicillin V) 1000 mg daily (usually 500 mg BID for 10 days).

OBJECTIVES: Description of the variability of routine antibiotic treatment prescribed by family physicians in the community for the treatment of acute tonsillitis (which represents a common diagnosis in primary care), and observation of the prescribed antibiotics adherence to the guidelines.

METHODS: Nine primary care physicians in urban clinics of Clalit Health Services, were included in the study. Information regarding 320 adult patients, 18 years of age or older, treated by them, was collected. Patients allergic to penicillin were not included. Comparison between the different medications was performed with relevant statistical tests.

RESULTS: Data regarding 95 men (30% of patients) and 224 women (70% of patients) was collected; the age range was 24 - 86 years old (average 38 years). Streptococcus group A was sensitive to all antibiotics prescribed; 70% (n=224) were prescribed with Penicillin V and the rest were given prescriptions for other antibiotics. From those who were given Penicillin V, 54% (n=121) were prescribed the recommended dosage (500 mg BID); 34% (n=77) were prescribed double dosage (1000 mg BID), whereas the rest of the patients received prescriptions for other dosages. Difference in treatment regimens was observed among the participating physicians regarding the choice and the dosage of the antibiotics they prescribed. In the medical files, there were no explanations regarding the different antibiotics or dosages.

CONCLUSIONS: Streptococcus A tonsillitis is a common diagnosis with wide consensus regarding the recommended antibiotic treatment. In spite of this consensus, there is significant prescribing variability among different physicians. This is emphasized by the fact that all the physicians who were included in the study work in urban clinics with similar characteristics. In view of the variation among primary care physicians regarding antibiotic prescription for a very common diagnosis, we see a need to investigate other treatment protocols for other common diagnoses. This is in order to ensure proper care and avoiding health complications while saving funds.