Background Tonsillitis is the third most frequently diagnosed infection in the pediatrics age group around the world. It causes significant morbidity and loss of school attendance in children. The emergence of drug resistance in bacterial tonsillitis is getting higher every year. However, data on the drug resistance profiles of bacterial causes of tonsillitis among children within five years of age is not available in Somaliland.Therefore; this study determined the bacterial causes of tonsillitis and their antimicrobial resistance profiles among children within five years of age at Hargeisa Group of Hospital, Somaliland. Methods A cross-sectional study was conducted from March to July 2020. A total of 374 children within five years of age were included using convenient sampling method. Throat swabs were collected from children, processed and bacterial species were identified using standard bacteriological procedures. Antimicrobial susceptibility was done using disc diffusion method. Data on demographic variables and clinical profiles were collected using structured questionnaires. Logistic regression analysis was computed to identify factors associated with bacterial tonsillitis. P-values < 0.05 were taken as statistically significant. Results The median age of children included in the study was 4 years. Overall, 120(32.1%)(95% CI 27.4–36.8%) of children had culture confirmed bacterial tonsillitis. Of them,23(19.2%) had mixed infections.The most frequent bacterial isolates were Streptococcus pyogenes 78(55%), Staphylococcus aureus 42 (29%) and Streptococcus pneumoniae 10(7%). Isolates revealed 83.3–100 % rate of resistance to ampicillin. S. aureus was resistant to clarithromycin (38%) while 60% of S. pneumoniae isolates were resistant to gentamicin. The overall multidrug resistance (MDR) was 50.4% and 52.6% of S.pyogenes and 60% of S.pneumoniae were MDR. History of tonsillitis(AOR = 0.12; 95% CI = 0.06–0.21), difficulty of swallowing(AOR = 6.99; 95% CI = 3.56–13.73), weight loss (AOR = 0.33; 95% CI = 0.186–0.597) and attending school (AOR = 2.98; 95% CI = 1.64–5.42) were found to be associated with tonsillitis among children within five years of age. Conclusions Bacterial tonsillitis with high degree of ampicillin resistance, mixed infections and MDR isolates are major concerns in children within five years of age at Hargeisa, Somaliland. Therefore, treatment of cases should be guided by regular culture and antimicrobial susceptibility testing to prevent disease consequences and critical drug resistance.

Introduction. Tonsillitis is the third most frequently diagnosed infection in the pediatric age and is associated with significant morbidity and loss of school attendance. Throat swab cultures are useful for the confirmation of children with a clinically suspected tonsillitis. However, Somaliland is one of the underdeveloped countries with a low standard of sanitation and poor health seeking culture. Treatment of tonsillitis with antibiotics is irrational and not empirical. This study determined the bacterial throat swab culture positivity and antibiotic resistance profiles of the bacterial isolates among children 2–5 years of age with suspicion of tonsillitis at Hargeisa Group of Hospital, Somaliland. Materials and Methods. A cross-sectional study was conducted from March to July 2020. A total of 374 children from 2 to 5 years of age suspicion of tonsillitis was included using a convenient sampling method. Throat swabs were collected, and bacterial isolation and identification were done using standard bacteriological procedures. Antimicrobial susceptibility testing was done using the disk diffusion method. Data on demographic variables and clinical profiles were collected using structured questionnaires. Logistic regression analysis was computed to identify factors associated with bacterial tonsillitis. Results. Overall, 120 (32.1%) (95% CI 27.4–36.8%) of children were positive for bacterial throat cultures. Of these, 23 (19.2%) were mixed bacterial isolates. The most frequent bacterial isolates were beta-hemolytic streptococci 78 (55%), Staphylococcus aureus 42 (29%), and Streptococcus pneumoniae 10 (7%). Isolates revealed 83.3–100% rate of resistance to ampicillin. Beta-hemolytic streptococci isolates were 94.9% resistant to ampicillin. S. aureus was resistant to clarithromycin (38%) while S. pneumoniae isolates were 100% resistant to ampicillin. History of tonsillitis (AOR = 0.12; 95% CI = 0.06–0.21), difficulty in swallowing (AOR = 6.99; 95% CI = 3.56–13.73), and attending schools (AOR = 2.98; 95% CI = 1.64–5.42) were found to be associated with positive throat culture. Conclusions. Resistance to ampicillin and MDR among beta-hemolytic streptococci and other isolates of throat colonizers in children with clinically suspected of bacterial tonsillitis are major concerns in Hargeisa, Somaliland. Therefore, treatments of cases are recommended to be guided by regular culture and antimicrobial susceptibility testing to prevent complications of tonsillitis and associated antibiotic resistance.