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Phenoxymethylpenicillin or amoxicillin for paediatric tonsillopharyngitis: a case of head versus heart?
  1. Michael Malley1,
  2. Isla Monaghan2,
  3. Katie Driver2,
  4. Megan Costelloe2,
  5. Lucy Jefferson3,
  6. Louise Poole1,
  7. Cliona Lewis1,
  8. Rachael Salt1,
  9. Robin Marlow1,4
  1. 1 Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  2. 2 University of Bristol Medical School, Bristol, Bristol, UK
  3. 3 Paediatrics, Bristol Royal Hospital for Children, Bristol, UK
  4. 4 Population Health Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Michael Malley, Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK; m.malley{at}

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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.

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Table 1

Reported prescribing practice for …

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  • 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.