The increased use of antibiotics for acute tonsillitis is a public health 
problem. 80% of the antibiotic prescriptions for acute tonsillitis are done in 
the Primary Care practice (PCP). The inappropriate use of the antibiotic causes 
bacterial resistance and treatment failure. Only patients with acute tonsillitis 
caused by Group A beta-hemolytic streptococcus (GAS) have benefit of the 
antibiotic treatment, which is a predict cause in 5-20%. In order to assess the 
antibiotic prescribing for acute tonsillitis by the doctors in the PCP in 
Macedonia we use the data from the national project about antibiotic prescribing 
for acute respiratory tract infections which was conducted in November 2014 
during a period of 4 weeks as part of the E-quality program sponsored by the 
IPCRG. 86 general practitioners from Macedonia have participated. The group of 
1768 patients, from 4 months to 88 years of age, with diagnosis of acute 
tonsillitis was analyzed. The antibiotic prescriptions according to the Centor 
score criteria were compared to the Cochran's guidelines which are translated 
and recommended as national guidelines. 88.8% of the patients with acute 
tonsillitis were treated with antibiotics, of which 52.9% with Centor score 0 to 
2 were treated inappropriate. The diagnosis is mostly made based on the clinical 
picture and the symptoms. Only (23.6%) of the patients were treated with 
antibiotics (Penicillin V and cephalexin) according to the guidelines. We 
concluded that there is a low adherence to the national guidelines. The clinical 
assessment is not accurate in determining the etiology. Also, there is a high 
nonadherence in prescribing the first choice of antibiotics. We emphasize the 
need to change the general practitioners' prescription behavior according to the 
guidelines.