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Tonsillitis

Updated : February 16, 2024





Background

The lateral oropharynx contains the palatine or faucial tonsils. The palatine arches or pillars are situated between the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly. Along with the adenoids (nasopharyngeal tonsil), lingual tonsil, and tubal tonsil, the tonsils are made of lymphatic tissue and make up Waldeyer’s ring.

They act as the initial immunological barrier to insults, offering a crucial line of protection against inhaled or ingested microorganisms. Tonsillitis, or tonsil inflammation, is a typical condition that accounts for 1.3 percent of patient visits.

It usually manifests as a sore throat and is mostly caused by a bacterial or viral infection. A definitive diagnosis is an acute tonsillitis. It might be challenging to distinguish between viral and bacterial causes but doing so is essential to avoid the misuse of antibiotics.

Epidemiology

A sore throat is a reason for about 2 percent of ambulatory patient visits in the US. The sickness can happen at any time of the year; however, it is more common in the winter and spring seasons.

15 percent to 30 percent of patients under the age of five and 5 percent to 15 percent of individuals over the age of 15 have GABHS. Patients under five are more likely to experience viral causative agents. In children younger than two years old, GABHS is uncommon.

Anatomy

Pathophysiology

Etiology

Tonsillitis typically results from an infection, which could be bacterial or viral. The most frequent causes are viral causes. Common cold-causing viruses such as the respiratory syncytial virus, rhinovirus, coronavirus, and adenovirus are typically the most prevalent viral culprits. Typically, they are not particularly virulent and rarely cause problems.

Tonsillitis can also be brought on by other viruses like Epstein-Barr (which causes mononucleosis), rubella, HIV, hepatitis A, and cytomegalovirus (CMV). GABHS (Group A beta-hemolytic Streptococcus) is the most common cause of bacterial infections; however, Staphylococcus aureus, Haemophilus influenza, and Streptococcus pneumoniae have all been grown.

Pathogens that are both anaerobic and aerobic can cause bacterial tonsillitis. Even so, Corynebacterium diphtheriae, which causes diphtheria, should be considered as an etiology in unvaccinated individuals. HIV, chlamydia, syphilis, and gonorrhea are possible additional causes in people who engage in sexual activity. Clinicians should evaluate their patients’ risks because tuberculosis has also been linked to recurrent tonsillitis.

Genetics

Prognostic Factors

In the lack of complications, the outcome for acute tonsillitis is very good. The majority of instances are self-limiting illnesses in healthier patient groups, which cure quickly and leave few long-term effects. Even though patients with repeated infections may need surgery, their long-term outcome is still favorable.

Even individuals with problems such as Lemierre syndrome and peritonsillar abscess have great long-term results in the age of antibiotics. The long-term effects of GABHS problems, such as glomerulonephritis and rheumatic fever, can include heart valve disease and impaired kidney function.

In the developed world, these entities are extremely uncommon, and incidence has decreased since penicillin therapy became available. If symptoms don’t get better, a different diagnosis, such as chlamydia, HIV, gonorrhea, TB, syphilis, abscess, Kawasaki illness, Lemierre syndrome, and mononucleosis, should be considered. The underlying illness in these circumstances affects the overall outcome.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

amoxicillin 

500

mg

2 times a day or 1 g daily

10

days


ER: 775 mg daily for 10 days



penicillin G benzathine 

1.2 million units given IM daily as a single dose



erythromycin ethylsuccinate 

400

mg

Orally 

divided in to 2 times a day

10

days



clarithromycin 

Indicated for Streptococcal pharyngitis:


250 mg oral tablet immediate release twice a day for 14 days



cephalexin 

250

mg

Capsule

Orally 

every 6 hrs



cefadroxil 

1

g

orally

daily

10

days


Note: indicated for pharyngitis and tonsillitis caused by Group A beta-hemolytic streptococci



azithromycin 

500 mg orally once a day, followed by 250 mg 4 times a day, on the 2nd to 5th day.



penicillin VK 

125 - 250

mg

Orally 

every 8 hrs

10

days



loracarbef 

Take 200 mg two times a day for ten days by oral route



dirithromycin 

500 mg is given orally once every day for 10 days



tyrothricin 

One lozenge orally
Note: do not chew or swallow the whole tablet
(or)
Throat spray
Initial dose: spray orally 1-2times in about 2-3hours
Maintenance dose: spray orally once every six hours
Indication: indicated for use in the treatment of swallowing difficulty due to infections like pharyngitis, gingivitis, tonsilitis, and sore throat



 

amoxicillin 

Children and Adolescents:  :


50 mg/kg/day orally daily or in divided doses 2 times a day for 10 days; may be increase up to 1,000 mg/day
  ER: 775 mg orally daily for 10 days 



penicillin v 

Age > 12 years:

125 - 250

mg

Orally 

every 6-8 hrs

10

days



penicillin G benzathine 

wt <27 kg: 600,000 U IM daily
wt > 27 kg: 1.2 million U IM daily



cefadroxil 

30

mg/kg

orally

daily



clindamycin 

Indicated for Streptococcal Pharyngitis:

20-30 mg/kg/day orally divided 3 times for Chronic carrier treatment
7 mg/kg/dose 3 times daily for 10 days for Acute treatment



cephalexin 

25 - 50

mg/kg

Capsule

Orally 

every 8 hrs

10

days



loracarbef 

Age six months-12 years- Administer 7.5 mg/kg two times a day for ten days by oral route with a maximum daily dose not exceeding 400 mg
Age 13 years/more- Take 200 mg two times a day for ten days by oral route



dirithromycin 

above 12 years: 500 mg is given orally once every day for 10 days



tyrothricin 

One lozenge orally
Note: do not chew or swallow the whole tablet
(Or) Throat spray
For children aged seven years and above:
Initial dose: spray orally 1-2times in about 2-3hours
Maintenance dose: spray orally once every six hours



 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK544342/

Tonsillitis

Updated : February 16, 2024




The lateral oropharynx contains the palatine or faucial tonsils. The palatine arches or pillars are situated between the palatoglossal arch anteriorly and the palatopharyngeal arch posteriorly. Along with the adenoids (nasopharyngeal tonsil), lingual tonsil, and tubal tonsil, the tonsils are made of lymphatic tissue and make up Waldeyer’s ring.

They act as the initial immunological barrier to insults, offering a crucial line of protection against inhaled or ingested microorganisms. Tonsillitis, or tonsil inflammation, is a typical condition that accounts for 1.3 percent of patient visits.

It usually manifests as a sore throat and is mostly caused by a bacterial or viral infection. A definitive diagnosis is an acute tonsillitis. It might be challenging to distinguish between viral and bacterial causes but doing so is essential to avoid the misuse of antibiotics.

A sore throat is a reason for about 2 percent of ambulatory patient visits in the US. The sickness can happen at any time of the year; however, it is more common in the winter and spring seasons.

15 percent to 30 percent of patients under the age of five and 5 percent to 15 percent of individuals over the age of 15 have GABHS. Patients under five are more likely to experience viral causative agents. In children younger than two years old, GABHS is uncommon.

Tonsillitis typically results from an infection, which could be bacterial or viral. The most frequent causes are viral causes. Common cold-causing viruses such as the respiratory syncytial virus, rhinovirus, coronavirus, and adenovirus are typically the most prevalent viral culprits. Typically, they are not particularly virulent and rarely cause problems.

Tonsillitis can also be brought on by other viruses like Epstein-Barr (which causes mononucleosis), rubella, HIV, hepatitis A, and cytomegalovirus (CMV). GABHS (Group A beta-hemolytic Streptococcus) is the most common cause of bacterial infections; however, Staphylococcus aureus, Haemophilus influenza, and Streptococcus pneumoniae have all been grown.

Pathogens that are both anaerobic and aerobic can cause bacterial tonsillitis. Even so, Corynebacterium diphtheriae, which causes diphtheria, should be considered as an etiology in unvaccinated individuals. HIV, chlamydia, syphilis, and gonorrhea are possible additional causes in people who engage in sexual activity. Clinicians should evaluate their patients’ risks because tuberculosis has also been linked to recurrent tonsillitis.

In the lack of complications, the outcome for acute tonsillitis is very good. The majority of instances are self-limiting illnesses in healthier patient groups, which cure quickly and leave few long-term effects. Even though patients with repeated infections may need surgery, their long-term outcome is still favorable.

Even individuals with problems such as Lemierre syndrome and peritonsillar abscess have great long-term results in the age of antibiotics. The long-term effects of GABHS problems, such as glomerulonephritis and rheumatic fever, can include heart valve disease and impaired kidney function.

In the developed world, these entities are extremely uncommon, and incidence has decreased since penicillin therapy became available. If symptoms don’t get better, a different diagnosis, such as chlamydia, HIV, gonorrhea, TB, syphilis, abscess, Kawasaki illness, Lemierre syndrome, and mononucleosis, should be considered. The underlying illness in these circumstances affects the overall outcome.

amoxicillin 

500

mg

2 times a day or 1 g daily

10

days


ER: 775 mg daily for 10 days



penicillin G benzathine 

1.2 million units given IM daily as a single dose



erythromycin ethylsuccinate 

400

mg

Orally 

divided in to 2 times a day

10

days



clarithromycin 

Indicated for Streptococcal pharyngitis:


250 mg oral tablet immediate release twice a day for 14 days



cephalexin 

250

mg

Capsule

Orally 

every 6 hrs



cefadroxil 

1

g

orally

daily

10

days


Note: indicated for pharyngitis and tonsillitis caused by Group A beta-hemolytic streptococci



azithromycin 

500 mg orally once a day, followed by 250 mg 4 times a day, on the 2nd to 5th day.



penicillin VK 

125 - 250

mg

Orally 

every 8 hrs

10

days



loracarbef 

Take 200 mg two times a day for ten days by oral route



dirithromycin 

500 mg is given orally once every day for 10 days



tyrothricin 

One lozenge orally
Note: do not chew or swallow the whole tablet
(or)
Throat spray
Initial dose: spray orally 1-2times in about 2-3hours
Maintenance dose: spray orally once every six hours
Indication: indicated for use in the treatment of swallowing difficulty due to infections like pharyngitis, gingivitis, tonsilitis, and sore throat



amoxicillin 

Children and Adolescents:  :


50 mg/kg/day orally daily or in divided doses 2 times a day for 10 days; may be increase up to 1,000 mg/day
  ER: 775 mg orally daily for 10 days 



penicillin v 

Age > 12 years:

125 - 250

mg

Orally 

every 6-8 hrs

10

days



penicillin G benzathine 

wt <27 kg: 600,000 U IM daily
wt > 27 kg: 1.2 million U IM daily



cefadroxil 

30

mg/kg

orally

daily



clindamycin 

Indicated for Streptococcal Pharyngitis:

20-30 mg/kg/day orally divided 3 times for Chronic carrier treatment
7 mg/kg/dose 3 times daily for 10 days for Acute treatment



cephalexin 

25 - 50

mg/kg

Capsule

Orally 

every 8 hrs

10

days



loracarbef 

Age six months-12 years- Administer 7.5 mg/kg two times a day for ten days by oral route with a maximum daily dose not exceeding 400 mg
Age 13 years/more- Take 200 mg two times a day for ten days by oral route



dirithromycin 

above 12 years: 500 mg is given orally once every day for 10 days



tyrothricin 

One lozenge orally
Note: do not chew or swallow the whole tablet
(Or) Throat spray
For children aged seven years and above:
Initial dose: spray orally 1-2times in about 2-3hours
Maintenance dose: spray orally once every six hours



https://www.ncbi.nlm.nih.gov/books/NBK544342/