Tonsillitis is a common disease of childhood and adolescence. The diagnosis of tonsillitis generally requires the consideration of Group A beta-hemolytic Streptococcus (GABHS) infection. However, numerous other bacteria alone or in combinations, viruses and other infections and non-infectious causes should be considered. Recognition of the cause and choice of appropriate therapy are of utmost importance in assuring rapid recovery and preventing complications.

Penicillin is currently the first-choice treatment for GABHS pharyngotonsillitis. However, the growing failure of penicillin to eradicate GABHS is of concern. This website discusses the potential causes of penicillin failure ( i.e. the presence of beta-lactamse producing bacteria that can “protect” GABHS from penicillins) and methods to overcome them. It also discusses the role of anaerobic bacteria in tonsillitis and its complications.

Thursday, October 25, 2012

New guideline for the treatment of pharyngitis

New guideline from the Infectious Diseases Society of America (IDSA) recommend that physicians should prescribe antibiotics only for patients with sore throats who have positive test results for a group A streptococcal (GAS) infection.

The recommendations include:
1. Because the clinical features alone do not reliably differentiate between GAS and viral pharyngitis swabbing the throat and testing for GAS by rapid antigen detection test (RADT) and/or culture should be performed except when clear viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present. In children and adolescents (and not in adults), negative RADT tests should be backed up by a throat culture.
2. Diagnostic studies for GAS pharyngitis are generally not indicated for children <3 years old and adults because acute rheumatic fever is rare in these groups.
3.  Routine follow-up throat cultures or RADT are not generally recommended.
4. Diagnostic testing or empiric treatment of asymptomatic household contacts of those with acute GAS pharyngitis is not routinely recommended.
5.   Those with acute GAS pharyngitis should be treated with an appropriate antibiotic at an appropriate dose for duration likely to eradicate the organism. Ten days treatment with penicillin or amoxicillin is recommended for those non-allergic to them.
6.  Treatment of penicillin-allergic patients  include a first generation cephalosporin (for those not anaphylactically sensitive) for 10 days, clindamycin or clarithromycin for 10 days, or azithromycin for 5 days.
7.  Adjunctive therapy with analgesic/antipyretic agent may be useful in the management of GAS pharyngitis. Corticosteroid is not recommended and aspirin should be avoided in children.
8.  GAS carriers do not generally require antimicrobial therapy because they are unlikely to spread GAS pharyngitis to their close contacts and are at little or no risk for developing suppurative or nonsuppurative complications.
9.  Tonsillectomy is not recommended solely to reduce the frequency of GAS pharyngitis.