Tonsillitis

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Introduction

Tonsillitis is an inflammatory condition of the palatine tonsils; it is common in children.

Half or more cases of the infection is caused by beta haemolytic streptococcus. Some are of viral origin.

Tonsillitis is typically an acute infection.
Chronic tonsillitis presents usually as recurrent acute infection.

It is essentially a disease of children but also occurs in young adults

Symptoms and clinical features of tonsillitis

  1. Fever
  2. Sore throat
  3. Dysphagia
  4. Systemic upset and malaise
  5. Tonsils are swollen, inflamed and covered with purulent exudates,
  6. Jugulo-digastric lymph nodes are enlarged. and tender

Differential diagnoses

  • Infectious mononucleosis
  • Vincent’s angina
  • Agranulocytosis

Complications of tonsillitis

  1. Quinsy: main common complication
  2. Parapharyngeal infection/abscess
  3. Rheumatic fever and nephritis following streptococcal tonsillitis

Investigations

  • Throat swab for microscopy, culture and sensitivity
  • Full Blood Count

Treatment for tonsillitis

Treatment objectives

  1. Control the infection
  2. Control pain
  3. Prevent further episodes

Non-drug treatment

  1. Oral hydration
  2. Salt/warm water gargle
  3. Tonsillectomy in chronic cases with frequent recurrent tonsillitis

Drug treatment

1. Antibiotics

Amoxicillin

  • Adult: 250-500 mg orally every 8 hours for 5 – 7 days
  • Child:
    • 40 mg/kg orally every 8 hours for 5-7 days
  • The parenteral route may be required when there is vomiting or severe dysphagia

Or:

Cotrimoxazole

  • Adult: 960 mg orally every 12 hours 5-7 days
  • Child
    • 6 weeks to 5 months: 120 mg orally every 12 hours;
    • 6 months – 5 years: 240 mg every 12 hours;
    • 6-12 years: 480 mg every 12 hours.

2. Analgesic

Paracetamol

  • Adult: 500 mg-1 g orally every 4-6 hours (to a maximum of 4 g) for 5-7 days
  • Child:
    • over 50 kg: same as adult dosing
    • 6-12years: 250-500 mg;
    • 3months-5years: 125 – 250 mg taken orally every 4-6 hours for 5-7 days.

Supportive measures

  • Bed rest
  • Intravenous infusion as necessary

Notable Adverse drug reactions

Cotrimoxazole

  • Fixed drug eruption
  • Nausea and vomiting
  • Erythema multiforme
  • Steven-Johnson syndrome

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