ear, nose, and throat disorders
Tonsillopharyngitis
Treatment of Tonsillopharyngitis
Symptomatic treatment Antibiotics for GABHS Tonsillectomy considered for recurrent GABHS 10 mg IM), which may help shorten symptom duration without affecting rates of relapse or adverse effects ( Treatment references ). Topical analgesics are available as lozenges and sprays; ingredients include Penicillin Vis usually considered the drug of choice for GABHS tonsillopharyngitis; dose is 250 mg orally 2 times a day for 10 days for patients<27 kg and 500 mg for those>27 kg.Amoxicillinis effective and more palatable if a liquid preparation is required. If adherence is a concern, a single dose of benzathine penicillin 1.2 million units IM (600,000 units for children≤27 kg) is effective. Other oral drugs include macrolides for patients allergic to penicillin, a 1st-generation cephalosporin, andclindamycin. Diluting over-the-counterhydrogen peroxidewith water in a 1:1 mixture and gargling with it will promote debridement and improve oropharyngeal hygiene. Treatment may be started immediately or delayed until culture results are known. If treatment is started presumptively, it should be stopped if cultures are negative. Follow-up throat cultures are not done routinely. They are useful in patients with multiple GABHS recurrences or if pharyngitis spreads to close contacts at home or school. .) Decisions should be individual, based on patient age, multiple risk factors, and response to infection recurrences ( Treatment references ). Numerous effective surgical techniques are used to perform tonsillectomy, including electrocautery dissection, microdebrider, radiofrequency coblation, and sharp dissection. Significant intraoperative or postoperative bleeding occurs in<2% of patients, usually within 24 hours of surgery or after 7 days, when the eschar detaches. Patients with bleeding should go to the hospital. If bleeding continues on arrival, patients generally are examined in the operating room, and hemostasis is obtained. Any clot present in the tonsillar fossa is removed, and patients are observed for 24 hours. Postoperative IV rehydration is necessary in≤3% of patients, possibly in fewer patients with use of optimal preoperative hydration, perioperative antibiotics, analgesics, and corticosteroids. 2 years who have preexisting severe obstructive sleep disorders and in patients who are morbidly obese or have neurologic disorders, craniofacial anomalies, or significant preoperative obstructive sleep apnea. Complications are generally more common and serious among adults. Accumulating evidence suggests that tonsillotomy (partial intracapsular removal of tonsil tissue), when done to treat various disorders is as efficacious as traditional tonsillectomy and preferable because of better outcomes related to pain, postoperative complications, and patient satisfaction ( Treatment references ). 1.Hayward G, Thompson MJ, Perera R, et al: Corticosteroids as standalone or add-on treatment for sore throat.Cochrane Database Syst Rev., 2012. doi: 10.1002/14651858.CD008268.pub2 2.Ruben RJ: Randomized controlled studies and the treatment of middle-ear effusions and tonsillar pharyngitis: how random are the studies and what are their limitations?Otolaryngol Head Neck Surg.139(3):333-9, 2008. doi: 10.1016 3.Wong Chung JERE, van Benthem PPG, Blom HM: Tonsillotomy versus tonsillectomy in adults suffering from tonsil-related afflictions: a systematic review.Acta Otolaryngol138(5):492-501, 2018. doi: 10.1080/00016489.2017.1412500 