Rationale Treatment of Tonsillitis and Peritonsillar Abscesses

Several options are considered when considering Quinsy tonsillitis and tonsillitis (Peritonsiller abscesses) . Treatment of acute tonsillitis is largely supportive and focuses on preserving hydration and tolerable caloric intake and on controlling pain and fever. The inability to maintain adequate intake of calories and oral fluids may require IV hydration, antibiotics and pain control. Intravenous home therapy under the supervision of qualified home care providers or the ability to oral patient intake ensures hydration.Intravenous corticosteroids can be controlled to reduce pharyngeal edema. The airway obstruction may require management by placing a nasal airway device, using intravenous corticosteroids and administering humidified oxygen. Observe the patient in a monitored environment until airway obstruction is resolved .

 Supportive therapy 

 Steroids:

Oral or intramuscular steroids in children and adolescents also show significant improvement in symptoms with minimal side effects and no adverse effect on disease progression. The best results were observed in streptococcal pharyngitis demonstrated for dexamethasone (10 mg), as well as in betamethasone  (8 mg) and prednisolone (60 mg) with a clear reduction in pain and sensation of disease, both in acute tonsillitis as in pharyngitis. 

Analgesics:

Non-steroidal anti-inflammatory drugs have been used successfully to relieve pain in children for more than 40 years (4). For acute tonsillitis, among counter substances, ibuprofen shows greater efficacy with minimal side effects compared to paracetamol and acetylsalicylic acid (ASA). Another advantage of ibuprofen is that the action lasts 6-8 hours longer than paracetamol. The therapeutic range of both substances is broad and with the correct dose, the safety potential is comparable. However, in case of overdose with paracetamol, liver damage is much more difficult to treat. In comparison, ASA showed significantly gastrointestinal side effects and should not be used for acute tonsillitis resulting in possible tonsillectomy due to the pronounced inhibition of platelet aggregation.

Diclofenac and ketorolac in children have fewer attack sites and are metabolized more rapidly, which is why the dose should be adjusted (higher doses than adults). Postoperative treatment, these substances play a role in the preservation of opioids, but as first-line therapy in pediatrics they are not suitable for sore throat. Metamizole is not recommended as a first or second choice analgesic in children due to the small but existing risk of agranulocytosis in the world literature.

Mouth Washes, Phytotherapy Lozenges and Roeder Method  

In a study in Turkey (blind and placebo-controlled), chlorhexidine antidepressants or benzydamine were tested, and showed improvement in symptoms in children and adults. Other studies are absolutely necessary to demonstrate efficacy sufficiently.

Typical herbal gargles contain sage, thyme and chamomile. Lubricate and maintain the mucous membranes. However, many contain ethanol as a solvent for extraction and are not approved for children and adults. Imupret ® coated tablets or drops are suitable for tonsillitis. These are approved for children for 2 years and are designed to act as a combination of 7 parts of anti-inflammatory and immunomodulatory. Another herbal product from the company for children is Tonsipret®. Contains capsaicin, lignum vitae and pokeweed in homeopathic doses. However, no reliable clinical studies have been found in homeopathy for acute tonsillitis . 

Nasturtium and horseradish root are contained in Angocin® tablets from REPHA GmbH Biological Pharmaceuticals, Langenhagen. Both plants are said to have antimicrobial, antiviral and antifungal effects. sidoides Pelargonium (EP 7630), known as Umckaloabo of South Africa, is marketed in Germany for children and was able to show significant improvement of symptoms compared to placebo in a clinical study in children with sore throat (not shown throat). There were no side effects. In some studies, herbal formulas from traditional Chinese medicine have shown significant advantages or even superiorities over antibiotics. However, not all of these studies are GCP compliant and not all have undergone a recent systematic review of their status. Pills containing benzocaine numb the oral mucosa and are often offered in combination with Sialorheologika (Lemocin® Forte, Dobendan Strepsils®). The increase in saliva flow acts as a disinfectant, maintains the mucous membranes and accelerates the healing process. These pills are, like all homeopathic medicines and most herbs, non-prescription drugs, that is, sold only in pharmacies, but are non-refundable and in general for children 2 years or older.

 In his book "The Natural Tonsil Treatment" of 1918, Roeder describes a method that is used more frequently today than before in many ENT practices. The tonsils full of debris are sucked with a glass suction cup, thus eliminating waste and massaging the tonsils at the same time, which (according to the current point of view) promotes lymphatic drainage. Thus, the tonsils are brushed or sprayed with disinfectant solutions. However, this method is more difficult to apply in children because the aspiration procedure is rather painful.

Definitive therapy for Bacterial Infections

Antibiotics:

Antibiotics are maintained for secondary bacterial pharyngitis. Because of the danger of a generalized papular rash, avoid ampicillin and associated compounds when infectious mononucleosis (MN) is suspected. Reactions related to oral antibiotics based on penicillin (eg Cephalexin) have been described. Therefore, start treatment with alternative anti-streptococcal antibiotics, for example erythromycin. Administer antibiotics if situations support a bacterial etiology, for example, the incidence of tonsil exudates, the onset of fever, leukocytosis, contacts that are sick or contact with a person who has a pyrogenic group beta-hemolytic streptococcus infection documented A ( GABHS). In many cases, bacterial and viral pharyngitis are clinically indistinguishable. It has not been shown that waiting for 1 or 2 days for the consequences of throat culture reduces the practicality of antibiotic treatment to avoid rheumatic fever .

 GABHS Infection and Antibiotic Use:

GABHS infection requires antibiotic coverage. Bisno et al stated in practice the guidelines for the diagnosis and management of GABHS that the desired treatment results for GABHS pharyngitis are the prevention of acute rheumatic fever, the prevention of supporting complications, the reduction of signs and symptoms clinicians. , the decrease in transmission of GABHS to close contacts and the minimization of the opposite effects of inadequate antimicrobial therapy. The administration of oral penicillin for 10 days is the best treatment for acute pharyngitis by GABHS. Intramuscular penicillin (ie penicillin G benzatin) is necessary for people who may not comply with a 10-day oral treatment .

Penicillin is ideal for most patients (except allergic reactions) because of its proven safety. Efficiency, narrow spectrum and low cost. The various anti-infection agents that have been found to be viable for GABHS pharyngitis are penicillin congeners, numerous cephalosporins, macrolides and clindamycin.

Clindamycin can have a specific value because its tissue infiltration is considered comparable for both the oral and intravenous organization. Clindamycin is vital in spite of living beings that are not quickly isolated (the impact of Eagle), which clarifies its extraordinary vitality for the GABHS disease. Vancomycin and rifampicin have also been invaluable. The reduced recurrence dose is prescribed to improve consistency with prescription regimes. An agreement on the adequacy of this assay has not yet been established. Most cases of severe pharyngitis are self-contracted, with clinical changes observed in 3-4 days. The rules of clinical practice state that maintaining a strategic distance from the anti-infection treatment for this day and this age is protected and a referral of up to 9 days from the beginning of the indication to antimicrobial treatment should maintain the significant drawback of GABHS (ie, intense rheumatic fever) (1).

Repetitive tonsillitis can be performed with an antimicrobial indistinguishable from severe pharyngitis by GABHS. In case the repetition of the contamination is not long after a treatment with an oral penicillin operator, at that moment consider the penicillin G benzatin IM. It appears that clindamycin and amoxicillin / clavulanic acid have been observed convincing in the annihilation of GABHS of the pharynx in people who have recurrent episodes of tonsillitis.

 A 3 to 6 week course of an anti-toxin against beta-lactamase (life triggers (eg Ex., Amoxicillin / clavulanic acid) may allow tonsillectomy to be kept at a strategic distance). the state of carrier must be treated when the family is full of rheumatic fever, a background marked by glomerulonephritis in the support, a spread of the "ping pong" disease between the family contacts of the carrier, the family concerns about the ramifications of transport GABHS a compelling episode in one, for example, a closed school, an outbreak of severe rheumatic fever, or when one might think of tonsillectomy to treat GABHS infinite commercial group. infectious outbreak within a closed community such as a school, an outbreak of acute rheumatic fever, or when considering tonsillectomy to treat chronic transport of GABHS.

Resistance to beta-lactamase from streptococcus species can now be observed in up to a third of community-based streptococcal infections. This resistance is perhaps the result of the existence of co-pathogens that are organisms that produce betalactamases, for example, H influenzae and Moraxella catarrhalis. These organisms can degrade the beta-lactam ring of penicillin and make a sensitive GABHS more resistant to beta-lactam antibiotics .

Tonsillectomy:

Tonsillectomy is specified for individuals who have experienced more than 6 episodes of streptococcal pharyngitis (confirmed by positive culture) in 1 year 5 episodes in 2 consecutive years or 3 or more infections during 3 years in a row, or chronic tonsillitis or recurrent related state of carrier of streptococcus that did not respond to antibiotics resistant to beta-lactamase. Tonsillectomy can result in children when multiple allergies or antibiotic intolerances are observed, as well as children with periodic fever, pharyngitis and adenitis (PFAPA), aphthous or peritonsillar history.

Blogger own experience of gargles with ginger is great. Ginger contain antibacterial gingerol which act superbly and my choice of treatment. Boil enough ginger in water that the boiled water produce a strange taste and gargle for 4-5 minutes and repeat every 2-3 hours.