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Background and Objectives:Acute tonsillitis is a clinical condition of gross tonsillar infection. Since previous studies focused on immunology of tonsils and group A β-hemolytic streptococcus, we have not had suficient clinical analyses of acute tonsil-that seem to be related to severe acute tonsillitis, such as age, sex, seasonal distribution, days from initial symptoms to visit, body temperature, symptoms, past history, duration of hospitalization, number of patients of culture positive group, culture organisms and antibiotic sensitivity of comon organism strains. Subjects and Method:In this study, researchers clinicaly reviewed 283 patients who were hospitalized at the Chung-Ang University Hospital at any time from January 1993 to December 2002. Throat smear was done at the surface of inflammed tonsils. Results:bacteria were isolated in 115 culture-positive cases. There were significant differences betwen Group A (from January 1993 to December 1997) and Group B (from January 1998 to December 2002) regarding organism strains isolated. In both Group A and B, group A β-hemolytic streptococcus was the most common organism that caused severe acute tonsillitis. However, in Group B, other organism strains, such as Pseudomonas aeruginosa and Enterococus, increased in number and in their resistance to pe-Conclusion:To sum up, this study demonstrates that we may reconsider the use of antibiotics such as penicillin and cephalothin for severe acute tonsillitis. This study calls for further studies about the change of organism strains that cause severe acute tonsillitis and about the predisposing factors that affect severe acute tonsillitis. (Korean J Otolaryngol 2003 ;46 :1051-7)