Tonsillitis and its complications are frequently encountered. Antibiotics cure most patients with bacterial tonsillitis, and surgery usually cures patients with infections and complications that are refractory to medical management. Better understanding of the immunology of tonsillitis, actively tracking patterns of bacterial and viral pathogenicity and resistance, and exploring novel technologies for tonsillectomy allow physicians to continue to build on their long experience with these conditions.
Tonsillectomy is indicated for individuals who have experienced more than six episodes of streptococcal pharyngitis (confirmed by positive culture) in 1 year, five episodes in 2 years consecutively, or three or more infections of tonsils and/or adenoids per year for 3 years in a row despite adequate medical therapy; or for chronic or recurrent tonsillitis associated with the streptococcal carrier state that has not responded to beta-lactamase–resistant antibiotics. Carrier state should be treated when the family has a history of rheumatic fever, a history of glomerulonephritis in the carrier, a "ping pong" spread of infection between household contacts of the carrier, familial anxiety regarding the implications of group A beta-hemolytic streptococci (GABHS) carriage, infectious outbreak within a closed community such as a school, an outbreak of acute rheumatic fever, or when tonsillectomy may be under consideration to treat the chronic carriage of GABHS.
Recurrent tonsillitis after tonsillectomy is extremely rare. Tonsillectomy reduces the bacterial load of GABHS and may also allow an increase in alpha-Streptococcus, which can be protective against GABHS infection. Recurrent tonsillitis is usually due to regrowth of tonsillar tissue, which is treated by excision.
Antibiotics are reserved for secondary bacterial pharyngitis. Because of the risk for a generalized papular rash, avoid ampicillin and related compounds when infectious mononucleosis is suspected. Similar reactions from oral penicillin–based antibiotics (eg, cephalexin) have been reported. Therefore, initiate therapy with another antistreptococcal antibiotic, such as erythromycin.
Peritonsillar cellulitis may respond to oral antibiotics. Antibiotics, either orally or intravenously, are required to treat peritonsillar abscess medically, although most peritonsillar abscesses are refractory to antibiotic therapy alone. Penicillin, its congeners (eg, amoxicillin/clavulanic acid, cephalosporins), and clindamycin are appropriate antibiotics. In rare cases of spontaneous peritonsillar abscess rupture, mouthwashes are still recommended for hygienic reasons. A 10-day course of an oral antibiotic is prescribed.
Read more about the treatment of patients with tonsillitis and patients with peritonsillar abscess.
This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases articles Pharyngitis, Tonsillitis and Peritonsillar Abscess, and Laryngitis.
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Cite this: Arlen D. Meyers. Fast Five Quiz: Sore Throat - Medscape - Nov 06, 2019.