What is tonsillitis?

  

 

sore throat and temperature membrane over the tonsils and enlarged and sore lymph glands general symptoms (headache, abdominal pain particularly in children, nausea, and vomiting) rapid onset of symptoms cough and rhinitis are evidence against group A streptococcal infection
1

20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Aetiology of tonsillitis


significant causative agents:

beta-haemolytic streptococci (groups A, C and G)  adenoviruses  Epstein-Barr virus


other causative agents:



various bacteria and viruses which are rare and with little significance on treatment

2
20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Diagnosis of tonsillitis The aim is to:



reliably identify group A streptococcal infections during epidemics testing is also done for group C and G streptococci

3
20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Diagnosis of tonsillitis 2


 

 

group A streptococcal infection cannot be reliably diagnosed on clinical symptoms and findings (A) antibiotic treatment should be based on isolation of beta-haemolytic streptococci from the throat (A) the main bacteriological investigation is a throat swab (the only acceptable one during an epidemic) (A) use of on the spot testing methods is justifiable only if results are available whilst the patient waits a positive on the spot test result is reliable a negative one should be counterchecked by bacterial culture
4

20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Antimicrobial therapy of tonsillitis



First choice:
Penicillin V 1-1.5 mega units twice daily for 10 days (more relapses with shorter treatment period (A) (A))

Second choice:
first generation cephalosporins (cefalexin 750 mg twice daily or cefadroxil 1g daily) or  procaine penicillin 1.2 1.5 mega units daily for 10 days  macrolides with caution (if local resistance patterns accept their use or they are indicated by sensitivity testing)

5

20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Treatment of tonsillitis 2


about 90% of patients with pharyngitis are asymptomatic within a few days of symptom onset whether they received antibiotics or not

Antibiotic treatment aims at

relieving patients symptoms sooner (A) and  preventing both complications (A) and epidemics


Symptomatic pain relief should also be remembered. Painkillers have a significant effect on pain, including pain on swallowing. (A)
6

20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Recurrent episodes of tonsillitis

4 or more episodes of group A streptococcal infections per year
 

90-96% carry beta-lactamase producing bacteria in the normal flora of their throat Other reasons:
poor compliance with treatment  new infection from a close contact  frequent episodes of viral infections in carriers


Treatment:
1. cefalexin or cefadroxil or  2. clindamycin 300mg twice daily for 10 days

7

20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

ENT referral?

when >4 episodes of beta-haemolytic streptococcal tonsillitis per year (despite

appropriate treatment)

  

prolonged or chronic illness when peritonsillar abscess fails to improve or recurs peritonsillar abscess in a child

8
20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES

Quality criteria for the treatment of tonsillitis

antibiotic therapy based on microbiological confirmation the majority of patients treated with narrow spectrum antibiotics treatment decision made within 24 hours patient informed also about symptomatic pain relief

   

9
20.6.2000

ANTIMICROBIAL TREATMENT STRATEGIES