to treatment effective against beta-lactamase producing bacteria such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins. There is no significant difference in efficacy of various groups of antibiotics for treating tonsillitis. Intravenous antibiotics can be for those who are hospitalized with inability to swallow and presented with complications. Oral antibiotics can be resumed immediately if the person is clinically improved and able to swallow orally. Antibiotic treatment is usually taken for seven to ten days. Pain medication Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to treat throat pain in children and adults. Codeine is avoided in children under 12 years of age to treat throat pain or following tonsilectomy. NSAIDs (such as ibuprofen) and opioids (such as codeine and tramadol) are equally effective at relieving pain, however, precautions should be taken with these pain medications. NSAIDs can cause peptic ulcer disease and kidney damage. Opioids can cause respiratory depression in those who are vulnerable. Anaesthetic mouthwash can also be used for symptomatic relief. Corticosteroids Corticosteroids reduce tonsillitis pain and improve symptoms in 24 to 48 hours. Oral corticosteroids are recommended unless the person is unable to swallow medications. Surgery When tonsillitis recurs frequently, often arbitrarily defined as at least five episodes of tonsillitis in a year, or when the palatine tonsils become so swollen that swallowing is difficult as well as painful, a tonsillectomy can be performed to surgically remove the tonsils. Children have had only a modest benefit from tonsillectomy for repeated cases of tonsillitis. Prognosis Since the advent of penicillin in the 1940s, a major preoccupation in the treatment of streptococcal tonsillitis has been the prevention of rheumatic fever, and its major effects on the nervous system and heart. Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection. An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading infectious thrombophlebitis (Lemierre's syndrome). In strep throat, diseases like post-streptococcal glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem