Sandbox:Tonsillitis medical therapy

Jump to navigation Jump to search

Tonsillitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tonsillitis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

USG

CT Scan

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Sandbox:Tonsillitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Sandbox:Tonsillitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Sandbox:Tonsillitis medical therapy

CDC on Sandbox:Tonsillitis medical therapy

Sandbox:Tonsillitis medical therapy in the news

Blogs on Sandbox:Tonsillitis medical therapy

Directions to Hospitals Treating Tonsillitis

Risk calculators and risk factors for Sandbox:Tonsillitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

The mainstay of therapy for tonsillitis includes analgesics and antimicrobial therapy. Antimicrobial therapy is recommended among patients with tonsillitis due to bacteria and the drug of choice is Penicillin. Viral tonsillitis is self-limited and usually resolves within one week. Supportive therapy includes salt water gargles and lozenges.

Medical Therapy

Bacterial Tonsillitis

  • If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line.[1]
  • Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.[2] A macrolide such as erythromycin is used for people allergic to penicillin.
  • Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria[3] such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.[4]

Antimicrobial Therapy

Complications in treatment

Despite in vitro efficacy, there is frequently reported inability of penicillin to fully resolve GABHS from patients with acute and relapsing tonsillitis.[6]

  • Over the past 50 years, the rate of penicillin failure has consistently increased from about 7% in 1950 to almost 40% in 2000.
  • There are several explanations for the failure of penicillin to eradicate GABHS tonsillitis:[7]
    • Poor penetration of penicillin into the tonsillar tissues, as well as the epithelial cells.[8]
    • Bacterial interactions between GABHS and the other members of the pharyngo-tonsillar bacterial flora.[9]
      • It is hypothesized that the enzyme beta-lactamase, secreted by beta-lactamase-producing aerobic and anaerobic bacteria that colonize the pharynx and tonsils, may “shield” GABHS from penicillin.
        • These organisms include S. aureus, Haemophillus influenzae, and Prevotella, Porphyromonas and Fusobacterium spp.[10] A recent increase was noted in the recovery of MRSA which was isolated from 16% of tonsils, making it more difficult to eradicate this and other beta-lactamase producing organisms.[11]
    • Coaggregation between Moraxella catarrhalis and GABHS, which can facilitate GABHS colonization.[12]
    • Absence of normal bacterial flora and resultant lack of interference on the growth of GABHS, makeing it easier for GABHS to colonize and invade the pharyngo-tonsillar area.[13][14][15]
    • Poor penetration of penicillin into the tonsillar cells and tonsillar surface fluid (allowing intracellular survival of GABHS)[8]
    • Resistance (i.e., erythromycin) or tolerance (i.e., penicillin) to the administered antibiotic
    • Inappropriate dose, duration of therapy, or choice of antibiotic

Symptomatic Treatment and Pain Management

If the tonsillitis is caused by bacteria,[17] then antibiotics are prescribed.[18] Penicillin is the most commonly used antibiotic.[19]

References

  1. Touw-Otten FW, Johansen KS (1992). "Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries". Fam Pract. 9 (3): 255–62. doi:10.1093/fampra/9.3.255. PMID 1459378.
  2. Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children. Pediatrics 2004;113:866-882.
  3. Brook I (2009). "The role of beta-lactamase-producing-bacteria in mixed infections". BMC Infect Dis. 9: 202. doi:10.1186/1471-2334-9-202. PMC 2804585. PMID 20003454.
  4. Brook I (2007). "Microbiology and principles of antimicrobial therapy for head and neck infections". Infect Dis Clin North Am. 21 (2): 355–91. doi:10.1016/j.idc.2007.03.014. PMID 17561074.
  5. Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  6. Casey JR, Pichichero ME (2007). "The evidence base for cephalosporin superiority over penicillin in streptococcal pharyngitis". Diagn. Microbiol. Infect. Dis. 57 (3 Suppl): 39S–45S. doi:10.1016/j.diagmicrobio.2006.12.020. PMID 17292576.
  7. Brook I, Foote PA (2005). "Efficacy of penicillin versus cefdinir in eradication of group A streptococci and tonsillar flora". Antimicrob. Agents Chemother. 49 (11): 4787–8. doi:10.1128/AAC.49.11.4787-4788.2005. PMC 1280135. PMID 16251332.
  8. 8.0 8.1 Kaplan EL, Chatwal GS, Rohde M. Reduced ability of penicillin to eradicate ingested Group A streptococci from epithelial cells: clinical and pathogenetic implications. Clin Infect Dis. 2006;43:1398-406.
  9. Brook I (1984). "The role of beta-lactamase-producing bacteria in the persistence of streptococcal tonsillar infection". Rev. Infect. Dis. 6 (5): 601–7. PMID 6390637.
  10. Brook I, Calhoun L, Yocum P (1980). "Beta-lactamase-producing isolates of Bacteroides species from children". Antimicrob. Agents Chemother. 18 (1): 164–6. PMC 283957. PMID 6968177.
  11. Brook I, Foote PA. Isolation of methicillin resistant Staphylococcus aureus from the surface and core of tonsils in children. Int J Pediatr Otorhinolaryngol. 2006 ;70:2099-102.
  12. Brook I, Gober AE (2006). "Increased recovery of Moraxella catarrhalis and Haemophilus influenzae in association with group A beta-haemolytic streptococci in healthy children and those with pharyngo-tonsillitis". J. Med. Microbiol. 55 (Pt 8): 989–92. doi:10.1099/jmm.0.46325-0. PMID 16849717.
  13. Grahn E, Holm SE (1983). "Bacterial interference in the throat flora during a streptococcal tonsillitis outbreak in an apartment house area". Zentralbl Bakteriol Mikrobiol Hyg A. 256 (1): 72–9. PMID 6362282.
  14. Brook I, Gober AE (1995). "Role of bacterial interference and beta-lactamase-producing bacteria in the failure of penicillin to eradicate group A streptococcal pharyngotonsillitis". Arch. Otolaryngol. Head Neck Surg. 121 (12): 1405–9. PMID 7488371.
  15. Brook I, Gober AE (1999). "Interference by aerobic and anaerobic bacteria in children with recurrent group A beta-hemolytic streptococcal tonsillitis". Arch. Otolaryngol. Head Neck Surg. 125 (5): 552–4. PMID 10326813.
  16. Boureau, F; Pelen, F; Verriere, F; Paliwoda, A; Manfredi, R; Farhan, M; Wall, R (1999). "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model". Clinical Drug Investigation. 17 (1): 1–8. doi:10.2165/00044011-199917010-00001. ISSN 1173-2563.
  17. Touw-Otten, Fransje Wmm; Johansen, Kirsten Staehr (1992). "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries". Family Practice. 9 (3): 255–262. doi:10.1093/fampra/9.3.255. ISSN 0263-2136.
  18. Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determine antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides
  19. Touw-Otten, Fransje WMM. and Kristen Staehr Johansen. "Diagnosis, Antibiotic Treatment and Outcome of Acute Tonsillitis: Report of a WHO Regional Office for Europe Study in 17 European Countries." Family Practice 9 (1992): 255-262 - 17 European Countries had a minimum of 10 physicians each that participated in a studied that involved 4094 patients that they had seen from Nov 1989 to May 1990. Sore throat, redness and swelling of tonsils, pus on tonsils, enlarge regional lymph nodes, or fever. Bacterial and serology test were performed to determined antibiotics usage. Antibiotics results had 2334 out of 3646 patient using penicillin. 343 out of the 3646 used amoxicillin and 554 out of 3646 used macrolides
  20. Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 1-8- Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories
  21. Boureau, F. and et al. "Evaluation of Ibuprofen vs Paracetamol Analgesic Activity Using a Sore Throat Pain Model." Clinical Drug Investigation 17 (1999): 1-8- Boureau studied 113 patients who saw 19 physicians in France. Patients were give Ibuprofen 400mg or Paracetamol 1000mg randomly. Pain intensity, difficulty swallowing, and global pain relief were use to measure in hourly increments until 6 hours after patients first dose. The results showed that Ibuprofen better than Paracetamol in all three categories
  22. "Tonsillitis - Treatment - NHS Choices".

Template:WH Template:WS