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Am Fam Physician. 2002;66(9):1735-1736

• Is tonsillectomy effective in severe tonsillitis in children and adults?
Unknown effectivenessTo be covered in future issues ofClinical Evidence
Tonsillectomy versus antibioticsIntermittent antibiotics
Long-term antibiotics
DefinitionTonsillitis is infection of the parenchyma of the palatine tonsils. Recurrent severe tonsillitis results in significant morbidity, including time lost from school or work. The definition of severe recurrent tonsillitis is arbitrary, but criteria used recently as a measure of severity were five or more episodes of true tonsillitis a year, symptoms for at least a year, and episodes that are disabling and prevent normal functioning.1
Incidence/PrevalenceAcute tonsillitis is more common in childhood.
Etiology/Risk FactorsCommon bacterial pathogens include beta hemolytic and other streptococci. Bacteria are cultured successfully only from a minority of people with tonsillitis. The role of viruses is uncertain.
PrognosisWe found no good data on the natural history of tonsillitis or recurrent sore throat in children or adults. Participants in randomized controlled trials (RCTs) who were randomized to medical treatment (courses of antibiotics as required) have shown a tendency toward improvement over time.2,3
Clinical AimsTo abolish tonsillitis; to reduce the frequency and severity of recurrent throat infections; to improve general well-being, behavior, and educational achievement, with minimal adverse effects.
Clinical OutcomesNumber and severity of episodes of tonsillitis or sore throat; requirement for antibiotics and analgesics; time off work or school; behavior, school performance, and general well-being; morbidity and mortality of surgery; and adverse effects of drugs.
Evidence-Based Medicine Findings

Tonsillectomy vs. Antibiotics

Limited evidence from one RCT suggests that tonsillectomy may benefit some children with severe tonsillitis. We found no good evidence on tonsillectomy in adults. We found that many important outcome measures have not been considered.

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