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Tonsillitis Prevalence, Diagnosis, and Treatment among Patients at Al-Baha

Region, Saudi Arabia

Article in Saudi Journal for Health Sciences · November 2023

DOI: 10.4103/sjhs.sjhs_128_23

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 Original Article

Tonsillitis Prevalence, Diagnosis, and Treatment

among Patients at Al-Baha Region, Saudi Arabia
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Rawan M. Alghamdi, Rajab Ahmed Alzahrani1, Abdullah Ali H. Alzahrani2, Fayez Saad Alghamdi3,
Mohammad A. Albanghali4, Shazia Shaheen Mir, Shaia Saleh Rajab Almalki
Departments of Laboratory Medicine, 2Dental Health and 4Public Health, Faculty of Applied Medical Sciences, Al‑Baha University,
1
Department of Surgery, Division of Otolaryngology, Faculty of Medicine, Al‑Baha University, 3Department of Medical Training and
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 11/27/2023

Education, King Fahad Hospital, Al‑Baha, Saudi Arabia

Address for correspondence:

Dr. Shaia Saleh Rajab Almalki, Background: Tonsillitis is considered one of the most otolaryngological diseases affecting
ABSTRACT

Department of Laboratory Medicine, children and adults. Tonsillectomy is one of the common surgical procedures mostly with children
Faculty of Applied Medical Sciences, and in cases of chronic tonsillitis or recurrent tonsillitis. Aims: The objective of this study was to
Al-Baha University, Al-Baha 65431, examine the incidence of tonsillitis, along with its methods of diagnosis and treatment, among
Saudi Arabia. patients residing in the Al-Baha region of Saudi Arabia. Settings and Design: A retrospective
E-mail: shalmalki@bu.edu.sa observational cross‑sectional analysis of tonsillitis patients who attended the pediatric, emergency
room, adult surgery, and ear, nose, and throat clinics at a hospital in Al‑Baha, Saudi Arabia,
from January 2019 to January 2023. Subjects and Methods: This research used purposive
sampling. Covered examining data acquired and analyzed 348 tonsillitis‑related throat swabs
and blood samples. Statistical Analysis Used: Data were statistically analyzed using the
Statistical Package for the Social Sciences software version 20.0 IBM (Armonk, New York, USA).
Results: A total of 348 patients diagnosed with tonsillitis were examined. Males had tonsillitis more
than females (n = 208, 60% and n = 140, 40%, respectively). The most frequent bacteria isolated
were Streptococcus pyogenes group A beta‑hemolytic, Staphylococcus aureus, methicillin‑resistant
S. aureus, and Klebsiella pneumoniae (n = 68, 19.5%; n = 24, 6.9%; n = 12, 3.4%; and n = 12,
3.4%, respectively). Conclusions: Tonsillitis is an oral and public disease affecting both children
and adults in Al‑Baha region. The emphasis should be on enhancing the public health system
to reduce tonsillitis and its consequences via effective awareness efforts. Hospitals may also be
urged to develop unique criteria for tonsillitis swabs in order to reduce contamination and improve
diagnosing the etiology of bacterial tonsillitis.

Submitted: 09‑Sep‑2023 Revised: 13‑Oct‑2023 Keywords: Diagnosis, oral health, public health, tonsillectomy, tonsillitis
Accepted: 19‑Oct‑2023 Published: 17-Nov-2023

INTRODUCTION by Candida albicans.[5,6] Bacterial tonsillitis has been classified

into three categories, i.e., acute tonsillitis which happens
Tonsillitis is considered to be one of the significant suddenly in a short time to patients, chronic tonsillitis which
infections.[1] It is a major oral health problem due to the is a long-term infection of the tonsils, and some references
growing incidence of the disease which might attack patients considered recurrent tonsillitis as another category of
many times in 1 year.[2] The morbidity of tonsillitis affects tonsillitis that may occur numerous times in a year.[7] The
most age groups, particularly the group aged between 3 and symptoms of tonsillitis include enlarged tonsils with red color,
10 years.[3] Tonsillitis most likely resulted from bacterial fever, headache, dysphagia, stomachache, swollen lymph
infections of different species; however, some reports have nodes, and hard breathing which may cause sleep disorders,
indicated that some cases of their infections were attributed especially in children.[8] Exploring the literature has revealed
to viral infections in the United States.[4] In addition, in some
cases, tonsillitis was a result of fungal infections, especially This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
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Quick Response Code the identical terms.
Website:
https://journals.lww.com/SJHS For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

How to cite this article: Alghamdi RM, Alzahrani RA, Alzahrani AA,
DOI: Alghamdi FS, Albanghali MA, Mir SS, et al. Tonsillitis prevalence, diagnosis,
10.4103/sjhs.sjhs_128_23 and treatment among patients in Al‑Baha region, Saudi Arabia. Saudi J Health
Sci 2023;12:227-34.

© 2023 Saudi Journal for Health Sciences | Published by Wolters Kluwer - Medknow 227
 Alghamdi, et al.: Prevalence of tonsillitis in Al‑Baha region, Saudi Arabia

that the bacterial causatives of tonsillitis include different the Lancefield test, antibiotic susceptibility testing, rapid
types of bacterial species, i.e., streptococci, staphylococci, antigen detection (RAD), and serology tests for antibodies
Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter against S. pyogenes antigens such as SLO or DNase B, as well
cloacae, Haemophilus, Peptococcus as Bacteroides species, as the C-reactive protein (CRP) test and Anti-Streptolysin
Fusobacterium species, and Lactobacillus species.[9] O titer (ASOT), are employed to identify and diagnose
cases of rheumatic fever. These tests are essential in
Streptococcus pyogenes (group A) and Streptococcus agalactiae understanding the immune response of the human body
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(group B) are Gram‑positive bacteria. They are considered to a specific type of throat infection caused by Group A,
to be the main causatives of tonsillitis.[10] Both groups of β-hemolytic streptococci (GaβHS)[30-36] Surgical procedures
bacteria share the same virulence factors that allow them of tonsillitis including tonsillectomy is one of the most
to resist immune mechanisms.[11] However, S. pyogenes performed surgical procedures, particularly with chronic,
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seemed to not only be more pathogenic as reported frequent, and recurrent tonsillitis.[37] Tonsillectomy often
worldwide but also existed in dental plaque and could be can perform in childhood, but some adults also undergo the
associated with chronic tonsillitis.[12] It has a propensity to removal of tonsils. Physicians are required this procedure
colonize the upper respiratory tract and make it difficult when the patients have complications or when the patients
to overcome easily.[13] It also has the ability to release have a tumor.[38] From a dental public health standpoint,
two important cytolysin toxins, i.e., streptolysin S and the absence of empirical data regarding the occurrence,
streptolysin O (SLO) which might be responsible for toxicity identification, and management of tonsillitis in Saudi
reactions in diverse cells.[14] Staphylococcus aureus was also Arabia as a whole, and specifically in the Al-Baha region, in
considered to be the second causative of tonsillitis after addition to the potential severe complications of tonsillitis
both streptococci groups A and B. Certain instances of and its correlation with inadequate oral hygiene, suggests a
chronic tonsillitis have been associated with Staphylococcus pressing necessity to investigate this area of study. Hence,
aureus infections[15] Several etiological studies indicated that the objective of this investigation was to examine the
S. aureus was one of the most common pathogens causing occurrence rate of tonsillitis, as well as the methods of
tonsillitis. Moreover, this bacterium has shown the ability diagnosing and treating the condition, among individuals
of resistance to antimicrobials and capability of persistence residing in the Al-Baha region of Saudi Arabia.
in the tonsil tissues, and it possesses some virulence factors
that facilitate tissue invasion. These all raised its medical SUBJECTS AND METHODS
significance.[16,17] Interestingly, methicillin‑resistant S. aureus
has been the less common reason for bacterial tonsillitis.[18] Participants and settings
A retrospective observational cross‑sectional study among
The complications of tonsillitis were found to be the main tonsillitis patients who had visited the pediatric, emergency
reason behind the deterioration of the patient’s condition, room, adult surgical, and ear, nose, and throat clinics during
especially in those who had recurrent or chronic tonsillitis the period of January 2019 to January 2023 at a hospital in
which may result in life‑threatening,[19] such as rheumatic Al‑Baha region, Saudi Arabia.
fever, scarlet fever, nephritis, and other complications which
may develop auto‑immune diseases.[20,21] Otitis media is Institutional Review Board Approval and Ethical
considered one of the other tonsillitis complications.[22] Considerations
Quinsy, also known as peritonsillar abscess, is characterized The present study was commenced after receiving an
by the development and occurrence of an abscess in the approval from Ethical Committee of Scientific Research
tonsils and throat walls.[23] Furthermore, obstructive sleep (ECSR) (Application number: (KFH/IRB10102022/3) at Training
apnea syndrome leads to complete or partial obstruction and Academic Education Department of the Saudi Ministry
of the airway during sleep in case of tonsil hypertrophy.[24] of Health in Al-Baha region, Kingdom of Saudi Arabia. This
This obstruction occurred due to enlargement of the tonsils, research contained no personally identifiable information.
especially in children.[25] The diagnosis of tonsil infection This was a secondary analysis of anonymized routine
usually starts with clinical features seen by physicians while monitoring data. Patient confidentiality was maintained
another diagnosis procedures are dependent on many during all research procedures.
factors as the patient’s history and physical examination
of the tonsils. [26] It is highly recommended to collect Sampling
tonsil swabs from patients with a history and signs by A purposive sampling technique was employed in this study.
using different tests to diagnose tonsillitis.[27] These tests A total of 348 samples including throat swabs and blood
include the following: throat culture is considered the samples of patients diagnosed with tonsillitis were collected
golden standard for diagnosing tonsillitis.[28] Additional and analyzed through covered reviewing records. Both throat
bacteriologic techniques include hemolysis, motility test, swabs and blood samples were collected from each patient.
Gram’s staining, and biochemical detection.[29] Additional The dataset used in this study consists of administrative
laboratory techniques, including microscopic analysis, claims data and discharge summary data. These data sources

228 Saudi Journal for Health Sciences - Volume 12, Issue 3, September-December 2023
 Alghamdi, et al.: Prevalence of tonsillitis in Al‑Baha region, Saudi Arabia

contain patient information related to baseline characteristics Table 1: Participants’ sociodemographic characteristics
such as age, gender, type of pathogen, and source of the Mean±SD Median (IQR) Frequency, n (%)
specimen. Additionally, information on medical procedures Age 12±12.2 8 (4–14) 348 (100)
like tonsillectomy and the complications associated with Children (0–14) 06±3.2 5 (3–8) 260 (74.7)
tonsillitis were also collected. Adult (15–62) 29.7±11.5 27.5 (23–32) 88 (25.3)
Gender
Data collection
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Female ‑ ‑ 140 (40)

A total of 348 isolates were obtained from throat and Male ‑ ‑ 208 (60)
blood samples among patients diagnosed with tonsillitis to SD: Standard deviation, IQR: Interquartile range
detect bacterial causative, complications, and antimicrobial
susceptibility. A susceptibility test was conducted using the
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Table 2: Clinical manifestations of tonsillitis patients

international standard protocol and following the instructions
Symptoms Frequency, n (%)
provided by the manufacturer (Phoenix 100). Information
Fever 308 (89.5)
from the medical records department regarding patient
Sore throat 184 (53.5)
demographics, specimen reception date, specimen sources,
Dysphagia 80 (23.3)
types of bacteria, and susceptibility test results were obtained.
Enlarge of tonsils 136 (39.5)
Fatigue 4 (1.2)
Data analysis
Vomiting 80 (23.3)
The database was generated in MS Excel, and data were
Cough 92 (26.7)
statistically analyzed using the Statistical Package for the
Pus on tonsils 84 (24.4)
Social Sciences software version 20.0 IBM (Armonk, New York,
USA). Descriptive analysis described the data. The median
and standard deviation were used for continuous data while Table 3: Distribution of bacterial organism’s identification
frequency and percentage for categorical variables. Graphs from tonsillitis patients
and tables show this study’s findings. Organisms Frequency, n (%)
S. pyogenes group A beta‑hemolytic 68 (19.5)
RESULTS S. aureus 24 (6.9)
P. aeruginosa 8 (2.3)
A total of 348 specimens including blood and mainly throat Methicillin‑resistant S. aureus 12 (3.4)
swabs were collected from tonsillitis patients [Table 1]. Males K. pneumoniae 12 (3.4)
were more exposed to tonsillitis than females (n = 208, E. cloacae 4 (1.1)
60% and n = 140, 40%, respectively). Children had the most Alpha‑streptococci, not pneumococcus 8 (2.3)
tonsillitis cases (n=260, 74.7%) followed by adults (n=88, Alpha‑hemolytic streptococci 8 (2.3)
25.3%). 96.6% of the patients were Saudi, while 3.4% were Normal flora 204 (58.6)
non‑Saudi patients. The initial diagnosis of tonsillitis patients Total 348 (100)
revealed that the most prevalent cases were diagnosed with S. aureus: Staphylococcus aureus, K. pneumoniae: Klebsiella pneumoniae,
acute follicular tonsillitis, acute tonsillitis, and recurrent E. cloacae: Enterobacter cloacae, S. pyogenes: Streptococcus pyogenes,
P. aeruginosa: Pseudomonas aeruginosa
tonsillitis (n = 224, 65%; n = 76, 22%; n = 32, 9%, respectively),
while less cases were diagnosed with pharyngotonsillitis,
Table 4: Distribution of bacterial isolates according to age
group
Bacterial Age group (years), frequency (%)
isolate Children Adults
Streptococcus 4 (7) 8 (66.6)
S. aureus 4 (7) 0
P. aeruginosa 4 (7) 0
No growth 44 (78.6) 4 (33.3)
Total 56 (100) 12 (100)
S. aureus: Staphylococcus aureus, P. aeruginosa: Pseudomonas aeruginosa

hypertrophy tonsillitis, and chronic tonsillitis (n = 8, 2%;

n = 4, 1%; and n = 4, 1%, respectively) [Figure 1].

Tonsillitis patients’ clinical symptoms are included in Table

Figure 1: Initial diagnosis of patients with tonsillitis 2. Among the subjects, tonsillectomy was performed on

Saudi Journal for Health Sciences - Volume 12, Issue 3, September-December 2023 229
 Alghamdi, et al.: Prevalence of tonsillitis in Al‑Baha region, Saudi Arabia

Table 5: Antibiotic susceptibility pattern Table 4, while the antibiotic susceptibility pattern is described
Antibiotics Number of specimens (%) in Table 5. Anti-Streptolysin O Titer test findings from the
Sensitivity Resistance serology laboratory on blood samples from people who have
Amoxicillin 104 (81.3) 24 (18.8) tonsillitis, broken down by frequency and percentage. Only
Ampicillin 76 (73.1) 28 (26.9) 12 of 348 blood samples (3.8%) tested positive for ASOT,
Gentamicin 48 (85.7) 8 (14.3) whereas the vast majority (n=336, 96.2%) tested negative.
Table 6 shows the antibiotics often given to individuals with
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Penicillin 72 (90) 8 (10)

Vancomycin 12 (75) 4 (25) a bacterial infection due to tonsillitis.
Ceftriaxone 44 (68.8) 20 (31.1)
Azithromycin 20 (71.4) 8 (28.6) DISCUSSION
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Imipenem 24 (66.7) 12 (33.3)

The incidence of tonsillitis among the participants in the
Cotrimoxazole 44 (84.6) 8 (15.4)
study is influenced by sociodemographic factors, with
Ciprofloxacin 52 (92.2) 4 (7.1)
notable differences observed in relation to age and gender.
Cefepime 8 (33.3) 16 (66.7)
The age groups illustrate that extreme tonsillitis cases were
Cephalexin 44 (84.6) 8 (15.4)
detected in children, while adults had lesser than children.
These observations were similar to other studies detected
Table 6: Prescribed antibiotics to patients that most of tonsillitis patients were children.[13,39] This
Antibiotics Frequency, n (%) could be attributed to the fact that children are not only
1st prescribed antibiotic still in the development phase of immunity to infections
Amoxicillin 200 (61.70) but also to the increased activity of children which
Azithromycin 8 (2.5) enhances exposure to infection than other ages. Another
Cefazolin 4 (1.2) justification of this might be the contact of children with
Cephalosporins 88 (27.20) each other in closed places such as schools. Moreover,
Cephalosporins 12 (3.70) the prevalence of tonsillitis was found to be greater in
Amoxicillin 4 (1.20) males (60%) than females (40%). This discovery is indeed in
Amoxicillin 4 (1.20) line with the findings demonstrated in numerous studies.
Ciprofloxacin 4 (1.20)
[7,15]
Moreover, in the present study, the initial diagnosis
2nd prescribed antibiotic of patients infected with tonsillitis demonstrated into six
Amoxicillin 4 (1.20) categories depending on the written records by physicians
Ceftriaxone 12 (3.70) including acute follicular tonsillitis, acute tonsillitis,
Vancomycin 4 (1.20) recurrent tonsillitis, pharyngotonsillitis, hypertrophy
3rd prescribed antibiotic tonsillitis, and chronic tonsillitis. The findings of several
Benzathine 4 (1.20) studies were consistent with the findings of the present
Penicillin 4 (1.20) study.[40‑43] Moreover, exploring the literature has revealed
that the most frequent clinical manifestations associated
with tonsillitis were fever and sore throat. It was found
(n=68; 19%). Males underwent tonsillectomy more than that 86% and 85% of tonsillitis patients mainly had fever and
females (n = 48, 3.8% and n = 20, 5.8%, respectively). sore throat.[44,45] Likewise in the present study, fever and
Moreover, the distribution of tonsillectomy among different sore throat were the most common symptoms associated
age groups revealed that children had tonsillectomy more with tonsillitis (89% and 54%, respectively).
than adults (n = 56, 16% and n = 12, 3.5%, respectively). The
laboratory results of individuals diagnosed with tonsillitis The study participants showed a prevalence of recurrent
revealed that among a total of 144 specimens, 41% tested tonsillitis at a rate of 9% (n=32). This occurrence has
positive for bacterial growth, while the other 59% exhibited significance due to its potential to give rise to complications,
no growth and were identified as normal flora. the possibility of antibiotic abuse or resistance development,
and its influence on the natural flora, particularly in the
Table 3 describes the distribution of bacterial organisms’ tonsils.[46] Tonsillectomy is recommended for patients who
identification from tonsillitis patients. The predominant have recurring tonsillitis.[47] Furthermore, data suggests
bacteria isolated from patients who had tonsillectomy were that treating recurrent tonsillitis with tonsillectomy to
Streptococcus, Staphylococcus aureus, and Pseudomonas avoid the consequences of Staphylococcus aureus infection
aeruginosa. Additionally, a significant proportion of patients and to avoid any problems caused by difficult-to-treat or
exhibited no bacterial growth, indicating the presence of persistent bacterial infections.[48] Tonsillectomy was done
normal flora. The percentages of these findings were 17.7%, on (n=68, 19.5%) of the study participants in the present
5.9%, 5.9%, and 70.6%, respectively (P = 0.03). The distribution study. This was much lower than recent studies that showed
of bacterial isolates according to age group is described in tonsillectomy was done in (n=137, 43.58%; and n=30,

230 Saudi Journal for Health Sciences - Volume 12, Issue 3, September-December 2023
 Alghamdi, et al.: Prevalence of tonsillitis in Al‑Baha region, Saudi Arabia

60%).[47,49] Yet, the difference of preforming tonsillectomy duration, and administration of incorrect antibiotics.[60]
between studies might be attributed to several factors Additionally, the current investigation has unveiled that
such as diagnosis, physician experience, treatment plan, Klebsiella pneumoniae, Alpha-Streptococci (excluding
targeted population, gender, and socioeconomic factors. Pneumococcus), and Alpha-Hemolytic Streptococci were the
Moreover, our study revealed that males were more exposed bacterial strains least frequently isolated in conjunction with
to tonsillectomy than females. Likewise, other research that Enterobacter cloacae. Several studies likewise mentioned the
found tonsillectomy was more prevalent among males than same bacterial isolates.[56‑58] Nonetheless, our study showed
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females.[50] The present study showed that tonsillectomy was that P. aeruginosa was rarely detected (2.3%) and found only
greater in children (n = 56, 21.5%) than adults 12 (14%). This in the children group. This also was confirmed by other
is consistent with the American Academy of Otolaryngology- research conducted in Nigeria.[59] It could be highlighted
Head & Neck Surgery Foundation’s recommendation, since that the main serologic test performed in this study with
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the majority tonsillectomy patients were minors aged 1-18 tonsillitis patients was the ASOT test for blood specimens.
years.[3] Bacteriological culture in this study illustrates Out of 348 blood specimens, most of those cases were
144 specimens that had positive bacterial growth in culture negative and only a few cases were positive ASOT (n = 336,
from total cases of 348 tonsillitis patients. A total of 248 96.2% and n = 12, 3.8%, respectively). However, another
specimens did not exhibit growth, suggesting the potential research discovered that (n=91, 25.9%) of patients had
presence of microorganisms that may be challenging to a streptococcus infection and that ASO titers were high
culture, such as fungus (e.g., in the case of candidiasis) (200 IU/ml) in (n=34, 37%) of patients.[60] Depending on the
and other agents. Another explanation could either be an treatment plan by the physician in this study, amoxicillin was
inappropriate use of antibiotics that cause the disappearance the most prescribed antibiotic for treatment (61.7%) followed
of the bacteria or the collection procedures of specimens by cephalosporins (27.7%). Compared to studies in the United
from the tonsil patients. The ratio of anaerobic to aerobic States that focus on antibiotic treatment for children infected
bacteria in the saliva is approximately 10:1 because of variants with sore throats depending on visits of patients, physicians
in oxygen concentration throughout the oral cavity. This may gave amoxicillin (26% of visits) as the highest percentage of
be due to found mostly of organisms were microaerophilic antibiotics prescribed.[61] Similar observation to our results
bacteria. This might be due to the fact that the majority of the detects that amoxicillin was equally effective and more
species found were microaerophilic bacteria. A study done in palatable.[62]
Saudi Arabia’s Khamis Mushait region supports this finding.[51]
Furthermore, gram stain analysis revealed that the majority On the contrary, alternative studies have advocated that
of the isolated bacteria were gram-positive bacteria, such as penicillin should be prioritized as the primary treatment
Streptococcus pyogenes group A beta-hemolytic, Staphylococcus option, with cephalosporin being a potentially viable
aureus, Methicillin Resistant Staphylococcus aureus, Alpha- alternative.[63] The difference of prescribing antibiotics could
Streptococci, and no pneumococcus or Alpha-Hemolytic be due to the different symptoms, diagnosis, treatment
Streptococci.[52] Gram-negative bacteria, on the other hand, plans, and patients’ allergies to specific type of antibiotics.
included K. pneumonia, P. aeruginosa, and E. cloacae. There was a key limitation to the present study centered
on the fact that it was really difficult to assess the causal
The results of the present study demonstrated that the most relationships between the variables of the study owing to
common cause of tonsillitis was S. pyogenes. This could be the cross‑sectional design. For instance, it was challenging to
attributed to the fact that it produced several virulence conclusively claim that the great prevalence of tonsillitis was
factors that facilitate the easy transmission of these bacteria caused by poor oral hygiene. However, the primary objective
by droplet spread within close contact between children of this study was to investigate and analyze the prevalence of
in school or in large families, and hence can increase the tonsillitis, as well as the methods of diagnosis and treatment,
possibility of the infection risk. Staphylococcus aureus ranked among patients residing in the Al-Baha region of Saudi Arabia.
as the second most prevalent bacterial organism, exhibiting a The study did not aim to investigate or establish any causal
variety of virulence characteristics that potentially contribute relationships between the variables. Although the current
to its invasiveness and pathogenicity, alongside its resistance research has limitations such as its cross‑sectional design
to multiple antibiotics. Similarly, a study in Nepal showed S. and a small sample size, it offers valuable insights into the
pyogenes and S. aureus as the common bacterial isolates from occurrence, diagnosis, and treatment of tonsillitis in the
tonsillitis patients.[53] Another study observed at Hail City in Al‑Baha governorate of Saudi Arabia.
Saudi Arabia found that S. aureus was the most common isolate
from throat swabs and other organisms and bacteria including CONCLUSIONS
group A β‑hemolytic streptococci, E. coli, and K. pneumoniae.[54]
MRSA was found in 3.4% of overall cases in the current The majority of tonsillitis patients in this research were
study. In contrast, alternative studies have demonstrated a children and men. On throat examination, the majority of
significant prevalence of MRSA at a rate of 58.11% attributed patients had a painful throat, fever, and red swollen tonsils.
to suboptimal antibiotic dosing, inadequate treatment On laboratory tests, the majority of patients had a high ASO

Saudi Journal for Health Sciences - Volume 12, Issue 3, September-December 2023 231
 Alghamdi, et al.: Prevalence of tonsillitis in Al‑Baha region, Saudi Arabia

titer. S. pyogenes group A beta‑hemolytic, S. aureus, MRSA, Ministry of Health in Al‑Baha region for cooperation and
and K. pneumoniae were the most often identified bacteria. facilitation of conducting this study.

The treatment options range from medicinal to surgical Financial support and sponsorship
tonsillectomy. Beta‑lactam antibiotics are still the most The authors extend their appreciation to the Deputyship
often prescribed antibiotics. The practice of doing cultural for Research and Innovation, Ministry of Education, in Saudi
sensitivity testing in the hospital is uncommon. Culture Arabia for funding this research work through the project
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sensitivity testing, on the other hand, should be promoted number MOE‑BU‑1‑2020.

in hospitals in order to promote sensible antibiotic usage.
Conflicts of interest
Recommendations There are no conflicts of interest.
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Recommendations include strengthening surgical

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