Clinical guide for the management of acute pharyngotonsillitis in adults

The acute pharyngotonsillitis (APT) in adults is one the most common infectious diseases in the family physician’s surgery. The most frequent etiology is viral. Within the bacterial etiology, the main agent responsible is Streptococcus pyogenes or streptococcus -GROUP A hemolytic (EBHGA), causing 5-30% of cases. In the diagnostic management, to predict the possible bacterial etiology, clinical evaluation scales are a good help for selecting which patients should undergo quick detection techniques for the streptococcic antigen. It is known that, in general, without these techniques streptococcic APT tends to be overdiagnosed, with the ensuing unnecessary prescription for antibiotics, often broad-spectrum. Thus, with the management of the steps and the quick diagnosis technique, we can draw up algorithms for managing APT. The objectives of the treatment are to accelerate the resolution of symptoms, reduce contagion time and prevent local suppurative and non-suppurative complications. The antibiotics of choice for treating streptococcic APT are penicillin and amoxicillin. The combination of amoxicillin and clavulanic acid is not indicated for the initial treatment of acute infection. Macrolides are not a first-choice treatment either; their use must be reserved for patients with allergy to penicillin. In our country it is important to adapt both the diagnosis of bacterial APT and the prescription of antibiotics to the scientific evidence available. The implementation of protocols of action in community pharmacies may be of use in identifying and screening cases that do not require antibiotic treatment.