Pharyngitis and Tonsillitis
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This is an infection of the throat and tonsils. Most sore throats are due to viral infections and should NOT be treated with antibiotics as they subside within 3 to 5 days. However, it is important to diagnose streptococcal pharyngitis since it may give rise to abscesses in the throat (retropharyngeal and peritonsillar abscess) as well as complications that involve organs like the kidneys and the heart. Streptococcal throat infections require treatment with antibiotics in order to reduce the complications noted above.
Cause
- Viruses
- Heamolytic streptococcus
- Haemophilus influenza
- Other gram positive bacteria
Symptoms
- Fever
- Difficulty in swallowing
- Sore throat
- Runny nose
- Cough
Signs
- Reddened throat
- Enlarged and reddened tonsils
- Sustained high grade fever
- Palpable tonsillar lymph glands (streptococcal pharyngitis)
- Runny nose (suggests viral)
- Cough (suggests viral)
- Red eyes (suggests viral)
- Whitish exudate at the back of the throat as well as whitish tonsillar exudate
- Scarlet fever rash
Investigations
- FBC
- Monospot test
- Throat swab for culture and sensitivity
TreatmentTreatment Objectives
- To relieve symptoms
- To recognise and treat streptococcal throat infection
- To relieve pain
Non-pharmacological treatment
- Warm, salty water gargles
Pharmacological treatment
For pain relief
1st Line Treatment
Evidence Rating: [A]
- Paracetamol, oral,
Adults
500 mg-1 g 6-8 hourly
Children
6-12 years; 250-500 mg 6-8 hourly
1-5 years; 120-250 mg 6-8 hourly
3 months-1 year; 60-120 mg 6-8 hourly
Or
- Ibuprofen, oral,
Adults
200-400 mg 8 hourly
Children
7-12 year; 7.5-10 mg/kg 6-8 hourly (max. 30 mg/kg or 600 mg per day)
4-7 years; 7.5-10 mg/kg 8 hourly (max. 30 mg/kg or 450 mg per day)
For treating the infection
1st Line Treatment
Evidence Rating: [A]
- Amoxicillin, oral,
Adults
500 mg 8 hourly for 10 days
Children
6-12 years; 250 mg 8 hourly for 10 days
1-5 years; 125 mg 8 hourly for 10 days
< 1 year; 62.5 mg 8 hourly for 10 days
Or
- Amoxicillin + Clavulanic Acid, oral,
Adults
1 gram 12 hourly for 10 days
Children
> 12 years; One 500/125mg strength tablet, 12 hourly for 10 days
6-12 years; 5ml of 400/57mg suspension 12 hourly (5ml of 250/62mg suspension 8 hourly for 10 days; dose doubled in severe infection)
1-6 years; 5 ml of 200/28.5 mg suspension 12 hourly for 10 days; dose doubled in severe infection
1 month-1 year; 2.5 ml of 200/28.5 mg suspension 12 hourly for 10 days; dose doubled in severe infection
Neonate;
2.5 ml of 200/28.5 mg suspension 12 hourly for 10 days; dose doubled in severe infection
Or
- Amoxicillin + Clavulanic Acid, IV,
Adults
600 mg-1.2 g 12 hourly for 10 days
Children
1-12 years; 15 mg/kg 12 hourly for 10 days
Or
- Crystalline Penicillin, IV,
Adults
2-4 MU 6 hourly for 10 days
Children
> 12 years; 2-4 MU 6 hourly for 10 days
1-12 years; 0.6-1.2 MU (25 mg/kg) 6 hourly for 10 days
Note: Do not give co-trimoxazole for acute streptococcal throat infections
2nd Line Treatment
Evidence Rating: [B]
- Cefuroxime, oral,
Adult
250 mg 12 hourly for 10 days
Children
> 12 years 250 mg 12 hourly for 10 days
3 months-12 years; 10 mg/kg 12 hourly for 10 days
Or
- Cefuroxime, IV,
Adult
750 mg 8 hourly for 10 days
Children
> 12 years; 750 mg 8 hourly for 10 days
3 months-12 years; 25-50 mg/kg 8 hourly for 10 days
For treating the infection in patients allergic to penicillin
- Erythromycin, oral,
Adults
500 mg 6 hourly for 10 days
Children
2-8 years; 250 mg 6 hourly for 10 days
1 month-2 years; 125 mg 6 hourly for 10 days
Neonates;
12.5 mg/kg 6 hourly
Or
- Azithromycin, oral,
Adults
500 mg daily for 3 days
Children
> 6 months; 10 mg/kg daily for 3 days
Referral Criteria
Refer patients with recurrent tonsillitis, retropharyngeal and peritonsillar abscess to an ENT specialist.