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.