ABSTRACT
ASO [Anti-sireptolysin O] antibody is formed in response to infection with streptococcal pyogenes. Measurement of ASO antibody titre is an important investigation of post streptococcal diseases, particularly rheumatic fever. Management of children with elevated levels of ASOT is still controversial some prefer medical therapy while other prefer surgical tonsillectomy. Is to define the best method of management of high ASOT through trial of three different therapeutic therapies which are the classic long acting BPG or recent macrolide oral azithromycin or tonsillectomy. The study enrolled 109 patients with a mean age 5.3 years. Group I [50 patients] were treated, with long acting BPG, Group II [40 patients] treated by oral azithromycin and Group III [19 patients] with tonsillectomy. Patients with failed medical treatment had undergone surgical tonsillectomy with follow up of their ASOT for 3 months. Surgical tonsillectomy revealed the highest curative rate 86.3% followed by long acting BPG 66% then oral azithromycin 62.5%. Conservative medical therapies should be the first line of management of high ASOT. Its failure urges the attempt for surgical tonsillectomy with a follow up period of 3 months at least for their ASOT