Treatment of acute pharyngitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG)
Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG) · 2024 · Italy
Source and licence
- Authors
- Elena Chiappini, Giovanni Simeone, Marcello Bergamini et al.
- Title
- Treatment of acute pharyngitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG)
- Journal
- Italian Journal of Pediatrics, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11539554
Licence statement of the original publication
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Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendation
- Antibiotic therapy is recommended in children with GABHS pharyngotonsillitis for a faster resolution of symptoms and a reduction in the risk of suppurative and non-suppurative complicationsQuality of evidence high. Strong recommendation in favour of intervention
Recommendations
- Amoxicillin is recommended as first-choice antibiotic drug in children with GABHS pharyngotonsillitis.Quality of evidence high. Strong recommendation in favour of intervention
Recommendation
- Given the lack of robust evidence regarding the efficacy and safety of different therapy durations in reducing the risk of suppurative and non-suppurative complications, amoxicillin for 10 days is recommended in children with GABHS pharyngotonsillitis. The latter regimen is recommended also in regions with a low ARF incidence.Quality of evidence very low. Weak recommendation in favour of intervention
Recommendations
- 4a. In patients with GABHS pharyngotonsillitis with suspected amoxicillin allergy who have not uderwent an allergological work-up, the choice of alternative antibiotic (3rd generation cephalosporins or macrolides) must be based on careful risk stratificationQuality of the evidence very low. Opinion of the experts. Strong recommendation in favour of intervention
- 4b. In patients with GABHS pharyngotonsillitis with suspected amoxicillin allergy and a low risk of an allergic reaction, a 3rd generation cephalosporin for 5 days should be recommended as an alternative therapy, restricting the use of macrolides to patients at high risk of severe allergic reactionsQuality of evidence very low. Weak recommendation in favour of intervention
Recommendation
- In the case of relapsing GABHS tonsillitis, antibiotic therapy should be recommended only in patients candidated to tonsillectomy, as an attempt to avoid surgery. In these cases, amoxicillin-clavulanic acid, clindamycin, or a combination of amoxicillin plus rifampicin in the last 4 days of treatment should be prescribed.Quality of evidence low. Weak recommendation
- In children with GABHS pharyngotonsillitis, a daily dose of amoxicillin (50 mg/kg/day) divided into 2 administrations may be recommended to improve treatment adherence.Quality of evidence low. Weak recommendation in favour of intervention.
Recommendations
- 7a. In children with GABHS pharyngotonsillitis, benzathine-penicillin therapy should only be recommended for subjects with reduced gastrointestinal absorption or inability to take oral therapies.High quality of evidence. Weak recommendation in favour of intervention
- 7b. In children with GABHS pharyngotonsillitis, benzathine-penicillin therapy may be recommended in case of poor adherence to oral amoxicillin, especially in patients at high risk of suppurative complications (such as in cases of primary or secondary immunodeficiency).Very low quality of evidence, expert opinion. Weak recommendation in favour of intervention
- 8a. Antibiotic therapy is not recommended in patients without comorbidities with pharyngotonsillitis and a culture and/or molecular test positive for bacteria other than GABHS.Quality of evidence moderate. Strong recommendation against intervention
- 8b. If antibiotic therapy for pharyngotonsillitis with a culture and/or molecular test positive for bacteria other than GABHS is considered appropriate, infectious disease counseling is recommended.Quality of evidence very low. Expert opinion. Strong recommendation in favour of intervention
Abstract
Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.
Supplementary Information: The online version contains supplementary material available at 10.1186/s13052-024-01789-5.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Results
- Question 1. Should Group A β-haemolytic streptococcus (GABHS) pharyngotonsillitis be treated with antibiotics?
- Question 2. Should amoxicillin be considered the antibiotic of choice in the treatment of GABHS pharyngotonsillitis besides penicillin V?
- Question 3. Should the duration of antibiotic therapy for GABHS pharyngotonsillitis be shorter than 10 days?
- Question 4. In children allergic to penicillin, which antibiotics can be administered for the treatment of GABHS pharyngotonsillitis?
- Question 5: Which antibiotic(s) should be recommended as first-choice therapy for relapsing GABHS pharyngotonsillitis despite several courses of amoxicillin?
- Question 6: which is the appropriate dosage of Amoxicillin in the treatment of GABHS pharyngotonsillitis?
- Question 7: May parenteral antibiotics, specifically intramuscular benzathine-penicillin, be recommended as treatment alternative to oral amoxicillin in selected GABHS pharyngotonsillitis patients?
- Question 8. Is it recommended to treat non-streptococcal bacterial pharyngotonsillitis (Fusobacterium spp., other anaerobes, Staphylococcus aureus, etc.) with antibiotic therapy?
- Discussion
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