Recurrent pharyngitis and tonsillitis

In patients with recurrent pharyngitis or tonsillitis, ensure that noninfective causes of sore throat have been addressed; these include gastro-oesophageal reflux, postnasal drip due to allergic rhinitis and rhinosinusitis, house dust mite allergy, cigarette smoking (including smoking by household members), dry air, snoring, and medications.

Given the challenges differentiating between bacterial and viral pharyngitis and tonsillitis, and the possibility that repeated detection of S. pyogenes may represent persistence of asymptomatic carriage, clinical judgement is required when interpreting culture results and assessing the need for antibiotic therapy in patients with recurrent pharyngitis or tonsillitis. However, as for the initial episode, patients at high risk of acute rheumatic fever with recurrent pharyngitis or tonsillitis should be treated with empirical antibiotic therapy for streptococcal infection.

Long-term antibiotic therapy is not recommended to prevent recurrent streptococcal pharyngitis or tonsillitis because of conflicting evidence about efficacy and concern about the development of antibiotic resistanceNg, 2015. Antibiotics also have poor penetration into the debris in tonsillar crypts.

Consider referral to an otolaryngologist if patients are severely affected by recurrent pharyngitis or tonsillitis (eg 7 or more episodes in one year, 5 or more episodes each year for 2 years, or 3 or more episodes each year for 3 years)Mitchell, 2019The Royal Children's Hospital Melbourne (RCH), Last updated May 2019.