Most episodes of acute (lasts less than 3 weeks) pharyngitis are due to viral
infection and usually resolve with conservative therapy (pain killers and
hydration). Group A streptococcal (GAS) infection in adults accounts for
approximately 10 percent of cases of pharyngitis.

In the
setting of recurrent acute pharyngitis with positive repeat diagnostic testing
(rapid test or throat culture), possible explanations are:

●Persistence of Streptococcus carrier state with active viral
infection

●Non-compliance to the antibiotic regimen (skipping doses or
cutting treatment duration short)

●New infection with GAS acquired from sick people around

In the setting of multiple recurrent infection episodes, distinguishing
between a true bacterial infection from viral pharyngitis becomes difficult. In
these circumstances, we resort to clindamycin
or amoxicillin-clavulanic acid to
eradicate streptococcal bacteria if those who are chronic carriers.

For adults to
be referred to undergo tonsillectomy, and in agreement with the guidelines of
the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) for
indications for tonsillectomy, they must fulfill the following criteria:

-      
3 episodes of tonsillitis yearly
for 3 years;

-      
5 episodes of tonsillitis yearly
for 2 years; or

-      
7 episodes of tonsillitis in
one year.

Prior to considering
tonsillectomy, each episode of pharyngitis should be clearly documented with
one or more of the following clinical features:

-      
temperature >38.3°C,

-      
cervical adenopathy
(enlarged and tender neck lymph nodes),

-      
tonsillar exudate (white
spots on the tonsils), or

-      
positive test for group A
beta-hemolytic streptococcus (GAS).