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Debate exists regarding antibiotic choice and treatment rationale in paediatric bacterial tonsillopharyngitis. To prevent potential complications of Group-A streptococcal (GAS) infection, which are rare in developed settings, the UK National Institute of Health and Care Excellence (NICE) recommends treating suspected GAS infections with 5–10 days’ phenoxymethylpenicillin (pen-V) using FeverPAIN or Centor criteria to identify bacterial aetiology.1
While updating local guidelines, we successfully contacted 153 of 180 (85%) English emergency departments (ED) to establish national practice. While 137 (90%) units use pen-V first-line, variation exists in dosing schedule and indication (table 1). Eleven units (7%) use amoxicillin and four (3%) offer both. For antibiotic rationalisation, 50% of units used clinical decision tools (FeverPain/Centor), 46% used no system and 4% reported using rapid GAS testing.
Contributors MM, IM, KD and MC were involved in all data collection, analysis and write-up of the article. LP, CL and RS performed national survey. LP and LJ performed literature search and revised the final article. RM supervised project and revised the final article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.