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Streptococcal Infection, Pharyngitis or Tonsillitis

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Pharyngitis or Tonsillitis

What complications can occur?

  • Persistence of infection is due to the existence of resistant bacteria, usually Staphylococcus aureus that produce beta-lactamase, in this case, being necessary to change the antibiotic;
  • Infection reoccurrence often due to reliance on medical recommendations, especially giving up early antibiotic treatment;
  • Painful swelling of the lymph nodes (submandibular, laterocervical);
  • Tonsillar phlegmon requiring, in addition to antibiotic treatment, discharge of pus (by your ENT specialist), and possibly tonsillectomy (surgical removal of tonsils) depending on the ENT advice; its development is suggested by an increased susceptibility to open mouth, sometimes unable to even drink liquid;
  • Otitis, sinusitis by disseminating infection in surrounding areas;
  • Necrotizing fasciitis a severe complication caused by so-called “flesh-eating bacteria” that destroys the tissues;
  • Acute rheumatic fever (ARF) a disease extremely common decades ago but whose frequency was significantly reduced by proper treatment and prophylaxis, of streptococcal infections, in addition to affecting the joints and heart damage with possible serious consequences;
  • Post streptococcal acute glomerulonephritis impairment of renal glomeruli with disturbance of renal function.

How is it treated?

The main objectives are:

– Eradication of infection – antibiotics according to the antibiogram.
– Temperature and pain control – pyretic, analgesic.
– Dietary-Hygienic measures.

Eradication of infection:

In case the suspicion of streptococcal infection is confirmed by a positive pharyngeal secretion, treatment of choice is the antibiotic, and the first tried is penicillin.

Only a doctor, a family doctor or pediatrician can determine the infection, respectively to recommend antibiotic treatment.

In practice, there are two situations:

a) Harvesting of pharyngeal secretion is necessary, after antibiotics are administered, to confirm the infection. If antibiogram confirms streptococcus sensitivity to initial antibiotic, continue with it for 10 days, in contrast, if streptococcus is not sensitive to initial antibiotic is received another antibiotic, according to the antibiogram.

b) Pharyngeal secretions are collected and are expected to confirm, respectively invalidate, the streptococcal infection without antibiotic treatment.

Penicillin is administered orally in mild to moderate cases, respectively intravenous or intramuscular if the child is hospitalized.

For those allergic to penicillin, other antibiotics can be used: Erythromycin, Clarithromycin, Azithromycin, Amoxicillin + Clavulanic Acid, Cefuroxime (rarely).

The duration of treatment is 10 days, except in the case of azithromycin (3-5 days). Even if symptoms are improving and the child apparently does not look ill, administration of antibiotic must be continued. If, in three days after the treatment, there are not signs of a favorable outcome ,then you should seek a new medical evaluation (ideally, the same doctor who evaluated the child at first).

In parallel with antibiotic therapy, probiotics can be taken to prevent a possible dysbiosis (destruction of “good” bacteria from the intestine by the action of the antibiotic that has no selective action).

Dietary-Hygienic regime:

  • Home insulation, possibly bed rest, depending on the severity of infection;
  • Consumption of fluids (warm tea, not hot, in which you can add lemon and honey; water; fruit juices; compotes; vegetable soups);
  • Gargling with salt water, 3-4 times a day, for older children;
  • Humid atmosphere, avoid overheating the house;
  • Avoid smoking around children.

When a tonsillectomy is necessary (surgical removal of tonsils) ?

The only able to determine this is the ENT specialist. In recent years, the number of these surgeries has decreased dramatically, in particular, due to early diagnosis and proper treatment.

There are a few criteria that can determine this indication:

  • Frequent infections, severe in terms of evolution (more than 5 episodes / year) always confirmed bacteriologically (pharyngeal secretion clearly establish the presents of beta hemolytic streptococcus);
  • Peritonsillar abscess (phlegmon);
  • Chronic reoccurrence of tonsillitis. Greatly affecting eating and breathing;
  • Influencing the daily activity by school absenteeism, sleep disorders, etc..

How can we prevent streptococcal infection?

Wash hands frequently

  • Avoiding crowded or confined spaces, because of the ease with which the infection is transmitted;
  • Isolation of sick children at home, thus preventing the spread of infection in nurseries and schools;
  • Avoid contact with sick people;
  • Wash hands frequently with soap and warm water;
  • Avoid smoking around children;
  • Periodic disinfecting toys and surfaces that children come into contact with more frequently;
  • Educating children to assimilate the minimum hygiene rules, primarily those relating to personal items (toothbrush, water glass, cutlery), even at home, each family member should care because the disease can spread to those who have no signs of disease.

In conclusion, dreaded tonsillitis is a common disease (rarely there are children who have not had streptococcal infection) but which, with the right treatment, is cured without sequelae, the best evidence is the dramatic decrease of cases of rheumatism fever.

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