Comprehensive Care in Tonsillitis: Surgical Interventions, Pharmacotherapy, and Nursing Management
Abstract
Background: Tonsillitis, an inflammatory condition of the palatine tonsils, is a leading cause of sore throat and represents a significant burden in outpatient care worldwide. While most cases are viral and self-limiting, bacterial infections, primarily Group A Streptococcus (GAS), require accurate diagnosis to guide appropriate treatment and prevent complications.
Aim: This article aims to provide a comprehensive overview of the management of tonsillitis, integrating surgical, pharmacological, and nursing perspectives to optimize patient outcomes through evidence-based diagnosis, treatment, and prevention of complications.
Methods: The review synthesizes current evidence on the etiology, evaluation, and management of tonsillitis. It examines the use of clinical scoring systems (e.g., Centor, McIsaac), rapid antigen testing, and throat cultures for diagnosis. Management strategies analyzed include supportive care, judicious antibiotic use, adjunctive corticosteroids, and the criteria for surgical intervention (tonsillectomy).
Results: Effective management hinges on distinguishing viral from bacterial etiologies to avoid unnecessary antibiotics. For confirmed GAS, penicillin or amoxicillin remains first-line therapy. Tonsillectomy is effective for patients meeting specific frequency criteria (e.g., Paradise criteria), significantly reducing recurrence and improving quality of life. A multidisciplinary approach is crucial for managing complications like peritonsillar abscess.
Conclusion: A collaborative, evidence-based approach is essential for high-quality tonsillitis care. This integrates accurate diagnosis, antimicrobial stewardship, and timely surgical referral when indicated, ensuring optimal patient outcomes and minimizing complications.
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References
Meegalla N, Downs BW. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 5, 2023. Anatomy, Head and Neck, Palatine Tonsil (Faucial Tonsils)
Masters KG, Lasrado S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 26, 2025. Anatomy, Head and Neck: Tonsils.
Kocher JJ, Selby TD. Antibiotics for sore throat. Am Fam Physician. 2014 Jul 01;90(1):23-4.
Null M, Arbor TC, Agarwal M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 6, 2023. Anatomy, Lymphatic System.
Bartlett A, Bola S, Williams R. Acute tonsillitis and its complications: an overview. J R Nav Med Serv. 2015;101(1):69-73.
Smith KL, Hughes R, Myrex P. Tonsillitis and Tonsilloliths: Diagnosis and Management. Am Fam Physician. 2023 Jan;107(1):35-41.
Putukian M, McGrew CA, Benjamin HJ, Hammell MK, Hwang CE, Ray JW, Statuta SM, Sylvester J, Wilson K. American Medical Society of Sports Medicine Position Statement: Mononucleosis and Athletic Participation. Clin J Sport Med. 2023 May 15;
González-Andrade B, Santos-Lartigue R, Flores-Treviño S, Ramirez-Ochoa NS, Bocanegra-Ibarias P, Huerta-Torres FJ, Mendoza-Olazarán S, Villarreal-Treviño L, Camacho-Ortiz A, Villarreal-Vázquez H, Garza-González E. The carriage of interleukin-1B-31*C allele plus Staphylococcus aureus and Haemophilus influenzae increases the risk of recurrent tonsillitis in a Mexican population. PLoS One. 2017;12(5):e0178115.
Alves METF, Mello LF, Alves FRF. Acute Epstein-Barr Virus and SARS-CoV-2 Coinfection: A Case Report. Curr Health Sci J. 2024 Jul-Sep;50(3):453-457.
Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gonzalez MD, Harrington A, Jerris RC, Kehl SC, Leal SM, Patel R, Pritt BS, Richter SS, Robinson-Dunn B, Snyder JW, Telford S, Theel ES, Thomson RB, Weinstein MP, Yao JD. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 05;
Pallon J, Rööst M, Sundqvist M, Hedin K. The aetiology of pharyngotonsillitis in primary health care: a prospective observational study. BMC Infect Dis. 2021 Sep 17;21(1):971.
Andersen C, Greve T, Reinholdt KB, Kjaerulff AMG, Udholm N, Khalid V, Madzak A, Duez C, Münch H, Pauli S, Danstrup CS, Petersen NK, Klug TE. Bacterial findings in patients referred to hospital for the treatment of acute tonsillitis with or without peritonsillar phlegmon. BMC Infect Dis. 2023 Jun 29;23(1):439.
Wang Q, Du J, Jie C, Ouyang H, Luo R, Li W. Bacteriology and antibiotic sensitivity of tonsillar diseases in Chinese children. Eur Arch Otorhinolaryngol. 2017 Aug;274(8):3153-3159.
Ben Ammar C, Tbini M, Kamel HE, Riahi I, Ben Salah M. Tonsillar tuberculosis mimicking tonsillar carcinoma: A case report. Int J Surg Case Rep. 2024 Aug;121:110032.
Klagisa R, Racenis K, Broks R, Balode AO, Kise L, Kroica J. Analysis of Microorganism Colonization, Biofilm Production, and Antibacterial Susceptibility in Recurrent Tonsillitis and Peritonsillar Abscess Patients. Int J Mol Sci. 2022 Sep 07;23(18)
Banigo A, Moinie A, Bleach N, Chand M, Chalker V, Lamagni T. Have reducing tonsillectomy rates in England led to increasing incidence of invasive Group A Streptococcus infections in children? Clin Otolaryngol. 2018 Jun;43(3):912-919.
Douglas CM, Lang K, Whitmer WM, Wilson JA, Mackenzie K. The effect of tonsillectomy on the morbidity from recurrent tonsillitis. Clin Otolaryngol. 2017 Dec;42(6):1206-1210.
Seidel DU, Bode S, Kostev K. Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019-2023). Eur Arch Otorhinolaryngol. 2025 Jan;282(1):317-326.
Gottlieb M, Long B, Koyfman A. Clinical Mimics: An Emergency Medicine-Focused Review of Streptococcal Pharyngitis Mimics. J Emerg Med. 2018 May;54(5):619-629.
Ebell MH, Call M, Shinholser J, Gardner J. Does This Patient Have Infectious Mononucleosis?: The Rational Clinical Examination Systematic Review. JAMA. 2016 Apr 12;315(14):1502-9.
Jääskeläinen J, Renko M, Kuitunen I. The impact of national guidelines on the diagnostics of sore throat in children. BMC Pediatr. 2024 Aug 06;24(1):503.
Shevale VB, Shinde RV, Patil SR. Bacteriological Profiles and Antimicrobial Susceptibility Patterns Among Isolates in Tonsillitis Patients Attending a Tertiary Care Hospital. Cureus. 2024 Oct;16(10):e72403.
Tirago TD, Worku M, Nima TM, Ormago MD. Microbial Composition, Antibiotic Sensitivity Patterns, and Contributing Factors Among Children With Tonsillitis in Hawassa Town, Sidama, Ethiopia. Int J Microbiol. 2025;2025:6366378.
Stelter K. Tonsillitis and sore throat in children. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2014;13:Doc07.
Schams SC, Goldman RD. Steroids as adjuvant treatment of sore throat in acute bacterial pharyngitis. Can Fam Physician. 2012 Jan;58(1):52-4.
ESCMID Sore Throat Guideline Group. Pelucchi C, Grigoryan L, Galeone C, Esposito S, Huovinen P, Little P, Verheij T. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012 Apr;18 Suppl 1:1-28.
Sidell D, Shapiro NL. Acute tonsillitis. Infect Disord Drug Targets. 2012 Aug;12(4):271-6.
Georgalas CC, Tolley NS, Narula PA. Tonsillitis. BMJ Clin Evid. 2014 Jul 22;2014
Ickrath P, Morbach H, Schwaneck EC, Gehrke T, Scherzad A, Hagen R, Hackenberg S. [Recurrent infections of the upper aerodigestive tract in patients with primary immunodeficiency]. HNO. 2019 Nov;67(11):819-824.
Morad A, Sathe NA, Francis DO, McPheeters ML, Chinnadurai S. Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review. Pediatrics. 2017 Feb;139(2)
Munck H, Jørgensen AW, Klug TE. Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review. Eur J Clin Microbiol Infect Dis. 2018 Jul;37(7):1221-1230
El Hennawi DED, Geneid A, Zaher S, Ahmed MR. Management of recurrent tonsillitis in children. Am J Otolaryngol. 2017 Jul-Aug;38(4):371-374.
Wilson JA, O'Hara J, Fouweather T, Homer T, Stocken DD, Vale L, Haighton C, Rousseau N, Wilson R, McSweeney L, Wilkes S, Morrison J, MacKenzie K, Ah-See K, Carrie S, Hopkins C, Howe N, Hussain M, Mehanna H, Raine C, Sullivan F, von Wilamowitz-Moellendorff A, Teare MD. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. Lancet. 2023 Jun 17;401(10393):2051-2059.
Nakayama T, Kaneko H, Suzuki Y, Okada A, Morita H, Fujiu K, Takeda N, Fukui A, Yokoo T, Takeda N, Yasunaga H, Nangaku M, Hayashi K. Chronic Tonsillitis and IgA Nephropathy: Findings From a Nationwide Japanese Cohort Study. Am J Kidney Dis. 2024 Nov;84(5):613-620.e1.
Thangaraj P, Sakthignanavel A, Kaliyamoorthy S, Thingujam S, Radhakrishnan V. Association of Helicobacter Pylori in Chronic Tonsillitis. Indian J Otolaryngol Head Neck Surg. 2024 Aug;76(4):3001-3006.
Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C., Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012 Nov 15;55(10):e86-102.
Sylvester JE, Buchanan BK, Silva TW. Infectious Mononucleosis: Rapid Evidence Review. Am Fam Physician. 2023 Jan;107(1):71-78.
Guntinas-Lichius O, Geißler K. [Diagnosis and Treatment of recurrent acute Tonsillitis]. Laryngorhinootologie. 2025 Apr;104(4):256-266.
Bernstein JA, Bernstein JS, Makol R, Ward S. Allergic Rhinitis: A Review. JAMA. 2024 Mar 12;331(10):866-877.
Bridwell RE, Koyfman A, Long B. High risk and low prevalence diseases: Adult epiglottitis. Am J Emerg Med. 2022 Jul;57:14-20.
Gupta G, McDowell RH. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 17, 2023. Peritonsillar Abscess.
Bohr C, Shermetaro C. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26, 2023. Tonsillectomy and Adenoidectomy.
Sievert M, Miksch M, Hinken N, Mantsoupoulos K, Gostian AO, Thimsen V, Mueller SK, Balk M, Rupp R, Iro H, Koch M. Predictive factors for abscessing tonsillitis: a retrospective analysis. Eur Rev Med Pharmacol Sci. 2023 Nov;27(21):10690-10696.
Conte M, Vinci F, Muzzi E, Canuto A, Barbi E, Cozzi G. Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses. J Paediatr Child Health. 2022 Mar;58(3):504-507.
Klug TE, Rusan M, Fuursted K, Ovesen T. Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection? Otolaryngol Head Neck Surg. 2016 Aug;155(2):199-207.
Walker MJ, Barnett TC, McArthur JD, Cole JN, Gillen CM, Henningham A, Sriprakash KS, Sanderson-Smith ML, Nizet V. Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev. 2014 Apr;27(2):264-301.
Gahleitner C, Hofauer B, Stark T, Knopf A. Predisposing factors and management of complications in acute tonsillitis. Acta Otolaryngol. 2016 Sep;136(9):964-8.
Bell Z, Menezes AA, Primrose WJ, McGuigan JA. Mediastinitis: a life-threatening complication of acute tonsillitis. J Laryngol Otol. 2005 Sep;119(9):743-5.
Klug TE, Greve T, Hentze M. Complications of peritonsillar abscess. Ann Clin Microbiol Antimicrob. 2020 Jul 30;19(1):32.
Rangen JK, Madsen MS, Kjærsgaard S. [Not Available]. Ugeskr Laeger. 2024 Sep 23;186(39)
Johannesen KM, Bodtger U. Lemierre's syndrome: current perspectives on diagnosis and management. Infect Drug Resist. 2016;9:221-227.
Mangerel J, Chung J, Lin YS, Derman A. Double trouble: Necrotizing tonsillitis in the setting of streptococcus pyogenes superinfection in a patient with Epstein-Barr virus. Radiol Case Rep. 2024 Dec;19(12):5967-5969.
Wang C, Duan L, Li P, Zhao W, Cao X. A case of suppurative tonsillitis as a complication of acute infectious mononucleosis. Sci Prog. 2025 Apr-Jun;108(2):368504251344169.
Kjærulff AMG, Fuglsang S, Klug TE. Peritonsillar abscess assessment tool. Dan Med J. 2024 Jul 17;71(8)
Portillo-Medina A, Golet Fors M, Penella Prat A, Manos M, Videla S, González-Compta X. Recurrent peritonsillar abscess in adults: Incidence and risk factors in a prospective longitudinal cohort. Acta Otorrinolaringol Esp (Engl Ed). 2024 Nov-Dec;75(6):361-366.
Jain H, Hohman MH, Sinha V. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 29, 2024. Retropharyngeal Abscess.
Almuqamam M, Gonzalez FJ, Sharma S, Kondamudi NP. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 11, 2024. Deep Neck Infections
Isankova O, Safronovs J, Berke K, Taurmane L. Deep Neck Infections. Review of 111 cases. Otolaryngol Pol. 2025 Jan 15;79(1):1-5.
Charlton A, Simon R, Shanthakunalan K, Simons A. Deep neck space infections: a UK centre, two-year, retrospective review of 53 cases. J Laryngol Otol. 2024 Dec;138(12):1161-1169.
Nieuwoudt I, Goussard P, Verster J, Dempers J. Tonsillar hypertrophy and prolapse in a child - is epiglottitis a predisposing factor for sudden unexpected death? BMC Pediatr. 2020 Jan 20;20(1):22.
Han F, Wu F, Ma M. Specific Measures and Benefits of Comprehensive Nursing Model in Clinical Practice for Pediatric Purulent Tonsillitis. Altern Ther Health Med. 2025 Jan 14
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