This handout is for recurrent tonsillitis & tonsillectomy candidacy (paradise criteria, aao-hnsf 2019 update). Your care team identified this based on: patient with documented recurrent throat infections — ≥3 episodes/year for ≥2-3 years or ≥5/year for 2 years or ≥7 in past year (paradise criteria, established paradise nejm 1984 pmid 6700642; reaffirmed aao-hnsf 2019 mitchell pmid 30798778).
Other reasons your team may use this plan: regular periodic fevers + aphthous stomatitis + pharyngitis + cervical adenitis pattern in a child — pfapa / marshall syndrome entry; tonsillectomy can be curative (aao-hnsf 2019 pmid 30798778); history of ≥1 peritonsillar abscess (quinsy) — aao-hnsf 2019 modifying factor that may favour tonsillectomy without strict paradise; multiple antibiotic allergies / intolerance limiting gas treatment — aao-hnsf 2019 modifying factor.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| penicillin V | adult 500 mg (child 250 mg) | PO | BID-TID × 10 days | IDSA 2012 Shulman (PMID 22965026); per-episode dosing OWNED by ent.pharyngitis.core.v1 — recapped here for documentation completeness |
| amoxicillin | 50 mg/kg (max 1 g) once daily OR 25 mg/kg BID | PO | once daily–BID × 10 days | IDSA 2012 Shulman (PMID 22965026) — once-daily palatable suspension improves pediatric adherence; AVOID if mononucleosis plausible (amoxicillin rash). Per-episode dosing OWNED by ent.pharyngitis.core.v1 |
| cephalexin | adult 500 mg BID | PO | BID × 10 days | IDSA 2012 Shulman (PMID 22965026) — first-gen cephalosporin acceptable for non-anaphylactic / non-severe penicillin allergy. Per-episode dosing OWNED by ent.pharyngitis.core.v1 |
| clindamycin | 7 mg/kg TID (adult 300 mg TID) | PO | TID × 10 days | IDSA 2012 Shulman (PMID 22965026) — preferred over macrolide where macrolide resistance concerns; counsel C. difficile risk. Per-episode dosing OWNED by ent.pharyngitis.core.v1 |
| azithromycin | adult 500 mg day 1 then 250 mg × 4 d (peds 12 mg/kg day 1 then 6 mg/kg × 4 d) | PO | once daily × 5 days | IDSA 2012 Shulman (PMID 22965026) — macrolide option for severe penicillin allergy; resistance variable (can exceed 10%). Per-episode dosing OWNED by ent.pharyngitis.core.v1 |
Plan: Recurrent tonsillitis — per-episode confirmed-GAS regimen (routed to acute pharyngitis engine for primary dosing) + AAO-HNSF 2019 perioperative bundle when tonsillectomy proceeds
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Pre-op: 6-12 monthly review with formal episode-and-documentation re-count; shared-decision conversation each visit. Post-op: review at 2-3 weeks for haemorrhage / hydration / pain (peak secondary bleed window day 5-10), at 6-8 weeks for symptom resolution + OSA re-evaluation (recurrence possible). Document primary + secondary bleeding outcome in medical record (AAO-HNSF 2019 requirement). Long-term: counsel that tonsillectomy benefit decays beyond 12 months in the moderately-affected group (Paradise Pediatrics 2002 PMID 12093941).
Guideline: AAO-HNSF Clinical Practice Guideline: Tonsillectomy in Children (Update) — Mitchell et al, Otolaryngol Head Neck Surg 2019 (PMID 30798778 full + PMID 30921525 Executive Summary). Paradise criteria established by Paradise et al, NEJM 1984 (PMID 6700642); moderately-affected children showed only modest benefit in Paradise et al, Pediatrics 2002 (PMID 12093941). All four PMIDs live-PubMed-verified 2026-05-26.