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.

Wednesday, September 9, 2015

Is tonsillectomy or adeno-tonsillectomy better than non-surgical approach for chronic/recurrent acute tonsillitis?

Tonsillectomy with or without adenoidectomy, is a common operation, but the indications for surgery are controversial. A Cochrane updated review by Burtton et al. of randomized controlled trials assessed the effectiveness of tonsillectomy (with and without adenoidectomy) in children and adults with chronic/recurrent acute tonsillitis in reducing the number and severity of episodes of tonsillitis or sore throat.

The review includes seven trials; five in children (987 participants) and two in adults (156 participants). The authors concluded that adeno-/tonsillectomy leads to a reduction in the number of episodes of sore throat and days with sore throat in children (5.1 fewer days) in the first year after surgery compared to non-surgical treatment. Children who were more severely affected were more likely to benefit as they had a small reduction in moderate/severe sore throat episodes.

In adults there were 3.6 fewer episodes (95% CI 7.9 fewer) in the group receiving surgery within six months post-surgery. The pooled mean difference for number of days with sore throat in a follow-up period of about six months was 10.6 days fewer in favor of the group receiving surgery (95% CI). Given the short duration of follow-up and the differences between studies, the authors considered the analysis found the evidence for adults to be of low quality. They concluded that insufficient information is available on the effectiveness of adeno-/tonsillectomy versus non-surgical treatment in adults to draw a firm conclusion.

The authors concluded that potential 'benefit' of surgery must be weighed against the risks of the procedure as adeno-/tonsillectomy is associated with a small but significant degree of morbidity in the form of primary and secondary haemorrhage and, even with good analgesia, and is particularly uncomfortable for adults.