Exploring the rising threat of antibiotic resistance in acute tonsillitis management in a rural Bangladeshi area: a study at Divine Mercy Hospital Limited, Gazipur

Abstract Background Acute tonsillitis management is severely challenged by antimicrobial resistance (AMR), particularly in rural Bangladesh where antibiotic misuse is prevalent. This study aimed to identify the primary bacterial etiologies of acute tonsillitis and their antibiotic susceptibility patterns to inform clinical practice in a resource-limited setting. Methods A cross-sectional study was conducted from November 2024 to June 2025 at Divine Mercy Hospital Limited, a tertiary hospital serving a rural population. Sixty patients with a clinical diagnosis of acute tonsillitis (modified Centor score ≥ 3) were enrolled. Throat swabs were analyzed for bacterial pathogens, and antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results Bacterial growth was identified in 48/60 samples (80.0%), with Streptococcus pyogenes being the predominant pathogen (35/48, 72.9%). S. pyogenes isolates demonstrated high resistance to trimethoprim-sulfamethoxazole, erythromycin, and tetracycline (> 80%). Among cephalosporins, resistance was widespread, with 100% of isolates non-susceptible to cefuroxime. A concerning 30–40% of isolates showed reduced susceptibility to penicillin and amoxicillin. All isolates remained susceptible to linezolid, carbapenems, and fluoroquinolones. Conclusion The extensive resistance of S. pyogenes to common oral antibiotics, including complete non-susceptibility to cefuroxime and reduced susceptibility to penicillin, renders empirical treatment based on standard guidelines unreliable in this region. These findings highlight an urgent need for local surveillance to guide evidence-based therapy and strengthen antimicrobial stewardship within the framework of Bangladesh’s National Action Plan for AMR.