Background: Acute follicular tonsillitis (A.F.T) is a common clinical illness often encountered in E.N.T practice. The treatment of this illness is frequently empirical, with antibiotic selection made without reference to culture data.

Objectives: To determine the failure rate in A.F.T treatment with amoxicillin clavulanate and to study the possible reason(s) for this failure in our locality.

Methods: An institutional-based cross-sectional study, included all pediatric patients (aged ≥ 5 to 18 years) with A.F.T who attending the outpatient ENT clinic of AUH in the period from December, 2020 to May, 2022. The culture of the throat swab was performed for all studied cases to identify the possible causative organism followed by antibiotic sensitivity test. All studied participants were received amoxicillin/ clavulanic acid initially for 2 – 3 days.

Results: The study included 66 patients, 57.6% were males. Positive culture was reported in 86.4% of throat swabs (Group A β- hemolytic streptococci was the most common isolated pathogen) and 13.6% had no growth after 72 hours on culture media. Gram positive bacteria were more susceptible to selected antibiotics than Gram negative bacteria. The majority of the isolated pathogens were susceptible to imipenem, ceftriaxone and levofloxacin with a good sensitivity. Amoxicillin/ clavulanic acid had a failure rate of 45.5% (30/66) in treating 66 pediatric patients with A.F.T.

Conclusion: The administration of amoxicillin/ clavulanic acid does not represent the best choice for treatment of acute A.F.T in pediatric patients.