Treatment Of Recurrent Tonsillitis Research Articles

Analysis of Microorganism Colonization, Biofilm Production, and Antibacterial Susceptibility in Recurrent Tonsillitis and Peritonsillar Abscess Patients.

Background: Despite the widespread use of antibiotics to treat infected tonsils, episodes of tonsillitis tend to recur and turn into recurrent tonsillitis (RT) or are complicated by peritonsillar abscesses (PTAs). The treatment of RT and PTAs remains surgical, and tonsillectomies are still relevant. Materials and methods: In a prospective, controlled study, we analyzed the bacteria of the tonsillar crypts of 99 patients with RT and 29 patients with a PTA. We performed the biofilm formation and antibacterial susceptibility testing of strains isolated from study patients. We compared the results obtained between patient groups with the aim to identify any differences that may contribute to ongoing symptoms of RT or that may play a role in developing PTAs. Results: The greatest diversity of microorganisms was found in patients with RT. Gram-positive bacteria were predominant in both groups. Candida species were predominant in patients with a PTA (48.3% of cases). Irrespective of patient group, the most commonly isolated pathogenic bacterium was S. aureus (in 33.3% of RT cases and in 24.14% of PTA cases). The most prevalent Gram-negative bacterium was K. pneumoniae (in 10.1% of RT cases and in 13.4% of PTA cases). At least one biofilm-producing strain was found in 37.4% of RT cases and in 27.6% of PTA cases. Moderate or strong biofilm producers were detected in 16 out of 37 cases of RT and in 2 out of 8 PTA cases. There was a statistically significant association found between the presence of Gram-positive bacteria and a biofilm-formation phenotype in the RT group and PTA group (Pearson χ2 test, p < 0.001). S. aureus and K. pneumoniae strains were sensitive to commonly used antibiotics. One S. aureus isolate was identified as MRSA. Conclusions: S. aureus is the most common pathogen isolated from patients with RT, and Candida spp. are the most common pathogens isolated from patients with a PTA. S. aureus isolates are susceptible to most antibiotics. Patients with RT more commonly have biofilm-producing strains, but patients with a PTA more commonly have biofilm non-producer strains. K. pneumoniae does not play a major role in biofilm production.

Effectiveness of TCM cauterization in recurrent tonsillitis: A protocol for systematic review and meta-analysis.

Recurrent tonsillitis (RT) is often treated with antibiotic therapy and surgery. Although these treatments have advantages, they are also controversial. The purpose of this study is to analyze the safety and effectiveness of traditional Chinese medicine (TCM) cauterization in the treatment of RT, so as to provide an alternative for the clinicians and to cover the shortage of therapeutic methods. This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and by the Cochrane Collaboration Handbook. We will formulate strict inclusion and exclusion criteria in English databases (PubMed, EMBASE, and Web of Science), Chinese databases (CNKI, Wanfang databases, CBM, and VIP), and search literatures in different clinical registration platforms (Cochrane Library, Chinese Cochrane Centre's Clinical Trial Registry Platform). The included articles will be evaluated using Cochrane RCT evaluation criteria. Stata 15.0 will be used for data analysis. Subgroup analysis, sensitivity analysis, and meta-regression will detect sources of heterogeneity. Egger's Test or Begg's Test will detect publication bias quantitatively. Cauterization can effectively control the recurrence of tonsillitis through clinical trials, but evidence-based medicine needs to be adopted to provide strong evidence for its effectiveness. The purpose of our research is to provide the evidence. DOI 10.17605/OSF.IO/PZ69Q.

A Comparative study to evaluate the effectiveness of Tonsillectomy with Long term Penicillin in the management of recurrent tonsillitis

Introduction: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery? This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT) and erythrocyte sedimentation rate (ESR). Methods: This study was carried out as a prospective study. A total of 100 Children were chosen for this study. Subjects fulfilling the inclusion criteria like , Age of 5–15 years , Children suffering from recurrent tonsillitis with signs of chronic tonsillitis: inequality in the size of the tonsils, enlarged cervical lymph nodes, and pus in the tonsillar crypts 6 , Severe attacks of tonsillitis: seven times in 1 year or five times in each of 2 years, or three times in each of 3 years & An ASOT of greater than 400 IU/ml and an ESR of greater than 30 ml/1 at 1/2 h 10,11.were selected by simple random sampling method. Results : The frequencies of occurrence of fever, cough, obstructive sleep apnea, unequal tonsil size, and pus in the tonsillar crypts were 80% , 51 % , 4% , 52% , and 48 %, respectively. Effect of tonsillectomy versus the effect of long-acting penicillin on ASOT, we found that the levels after 3 months were lower in patients who were treated by tonsillectomy than in those who were treated with long-acting penicillin; the difference between both the groups was found to be statistically significant. Conclusion: This study presents important insight into the alternate treatment regimens of Recurrent Tonsillitis in rural children. This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.

Management of recurrent tonsillitis in children

ObjectiveTo compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children. MethodsThe study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000IU for children≤27kg and 1,200,000IU for ≥27kg) every two weeks for six months. Group B children received single oral AZT (250mg for children≤25kg and 500mg for ≥25kg) once weekly for six months. ResultsBoth groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance. ConclusionAZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

Acute-phase reactants in children with recurrent tonsillitis treated by tonsillectomy versus long-acting penicillin

EnAbstract Introduction Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery? This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT) and erythrocyte sedimentation rate (ESR). Patients and methods A total of 200 patients aged 4–15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, who were attending the Ismailia General Hospital were included in this study; they were divided to two groups comprising 100 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated; ESR and ASOT levels were recorded for all patients before management, after 3 months, and after 6 months. Results The mean ESR readings before management, after 3 months, and after 6 months for the first group treated by tonsillectomy were 45.28, 22.36, and 7.4 ml/h, respectively (P-value&lt;0.0021); for the second group treated with penicillin, they were 45.39, 14.98, and 6.48 ml/h, respectively (P-value&lt;0.020). The mean ASOT readings for the tonsillectomy group were 518.29, 253.28, and 117.13 IU/ml, respectively (P-value&lt;0.004), whereas for the penicillin group, they were 526.70, 413.39, and 262.98 IU/ml, respectively (P-value&lt;0.072). Conclusion This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.

HEV, PGS, GABA, Chronic Tonsilitis

To compare azithromycin (AZT) and benzathine penicillin (BP) in the treatment of recurrent tonsillitis in children.The study comprised of 350 children with recurrent streptococcal tonsillitis, 284 of whom completed the study and 162 children received conventional surgical treatment. The rest of the children, 122, were divided randomly into two equal main groups. Group A children received a single intramuscular BP (600,000 IU for children ≤ 27 kg and 1,200,000 IU for ≥ 27 kg) every two weeks for six months. Group B children received single oral AZT (250 mg for children ≤ 25 kg and 500 mg for ≥ 25 kg) once weekly for six months.Both groups showed marked significant reduction in recurrent tonsillitis that is comparable to results of tonsillectomy. There were no statistical differences between group A and B regarding the recurrence of infections and drug safety after six-month follow-up. Group B showed better compliance.AZT proved to be good alternative to BP in the management of recurrent tonsillitis with results similar to those obtained after tonsillectomy.

On the Treatment of Recurrent Tonsillitis by Vaccination

SummaryThis paper reports on the experience of using vaccination in the treatment of recurrent tonsillitis.All of the 82 patients, who were aged between 5 and 67 years and who suffered from recurrent tonsillitis, were given an injection of a bacterial vaccine (Broncasma Berna, Swiss Serum Institute, Berne) that has been used in many countries for three decades. A dose of 0.05 ml was given once every 4 to 14 days (average once a week) on 3 to 20 occasions (average 8). The treatment prevented 75 of the 82 patients (91 %)from having attacks of recurrent tonsillitis for extended periods. These 75 patients included three who relapsed into recurrent tonsillitis in spite of having tonsillectomies. As the dose used was relatively small, none of the patients complained of spontaneous pain or fever although three complained of slight tenderness at the injection point on the following day. The effect on recurrent tonsillitis of the Paspat intracutaneous injection (Luitpold Werk, Munich) has also been investigated recently. It was eflective in two patients who did not respond to Broncasma Berna.In this retrospective study, low doses of bacterial vaccine reduced the incidence of recurrent tonsillitis and were well tolerated.

Pharyngitis.

Preview Depending on the cause, pharyngitis may be a relatively benign symptom or an ominous harbinger of severe sequelae, including rheumatic fever. Therefore, accurate diagnosis and appropriate treatment are important to avoid potentially serious complications. Drs Bonilla and Bluestone discuss the most common causes of pharyngitis, the diagnostic workup, and the current symptomatic and antimicrobial therapies. Treatment of recurrent tonsillitis is also included.

Fine-Needle Aspiration in Recurrent Tonsillitis

The incidence of tonsillitis that is unresponsive to penicillin therapy is leading to concern. This phenomenon has been linked to a change in the core tonsil bacteria, in particular beta-lactamase production. To date, the only way to identify the presence of these resistant microbes is at tonsillectomy. In this prospective study, we performed fine-needle tonsil aspiration in 34 patients (mean age, 7.6 years) before tonsillectomy. The bacteriologic nature of the aspirate was compared with that obtained from culturing the tonsillar surface (in situ) and core of the resected tonsils. The bacteriologic findings of the aspirate corresponded closely with those of the tonsil core (qualitative and quantitative comparison), while the superficial swab was of limited value in predicting the core bacteria. Based on this study, tonsil fine-needle aspiration may have a place in the treatment of recurrent tonsillitis.

Effect of Amoxycillin/Clavulanic Acid on the Aerobic and Anaerobic Tonsillar Microflora in the Treatment of Recurrent Tonsillitis

30 patients with recurrent tonsillitis were treated with amoxycillin/clavulanic acid (500 mg/125 mg) t.i.d. for 10 days. The most often isolated potential aerobic pathogenic bacteria were Staphylococcus aureus, Streptococcus milleri and Haemophilus parainfluenzae. Group A streptococci were isolated from 7 patients. Anaerobic cocci and Bacteroides species were the dominating anaerobic bacteria isolated from the tonsils. Tonsillar cultures were taken before antibiotic treatment started, on days 11-12, day 30, and day 90. Beta-lactamase producing aerobic and anaerobic bacteria were present in 13 patients prior to treatment, on days 11-12 in 18 patients, on day 30 in 15 patients, and on day 90 in 13 patients. Group A streptococci were eradicated in 6/7 patients. In the aerobic tonsillar microflora, the numbers of viridans streptococci decreased during treatment but were normalized after 30 days. Only minor changes in the numbers of other aerobic microorganisms occurred during the investigation. The effect on the anaerobic microflora was minor and no new colonizing microorganisms were isolated during or after antibiotic treatment. All patients except one were cured on days 11-12. Five patients had another episode of tonsillitis during the observation period of 3 months. The antibiotic treatment was well tolerated in most patients and mild adverse events such as nausea, vomiting and diarrhoea were observed in 3 patients.

Immunological basis of indications for tonsillectomy and adenoidectomy.

The tonsils are immune organs. The necessity for T & A should have a more rational approach for selected cases. The tonsils have a large immune function. The defense function of the tonsils is much greater in children than in adults. The children develop their resistance to infection by the time they are 7-8 years old. Tonsils and adenoids should not be removed below the age of eight unless there are absolute indications. Tonsillectomy has little or no effect on allergy. It is being done on account of tonsillar sepsis, and no other results are to be expected. In cases of obstructive tonsillar hypertrophy in young children, unilateral tonsillectomy is indicated. T & A are two separate operations, each with their own indications. Tonsillar focality could be regarded as a qualitative alteration in tonsillar antibody formation. The treatment of recurrent tonsillitis is related to the age of the patient. The solution to the problem up to an age of about 12 is quite different from that in older people. Alternatives to surgery are immunotherapy, intermittent chemotherapy and observation.

Beta-Lactamase-producing anaerobic bacteria in recurrent tonsillitis.

Clinical studies have emphasized the importance of anaerobic bacteria in recurrent tonsillitis. These bacteria are usually sensitive to penicillin. However, recent reports have demonstrated that penicillin-resistant Bacteroides strains can be isolated from inflamed tonsils. These strains are resistant to penicillin due to β-lactamase production and the strains may therefore be responsible for the failure of penicillin in the treatment of recurrent tonsillitis. Ten patients with recurrent tonsillitis were given 1 g tinidazole every 24 h for 7 days, 21 patients 0·15 g clindamycin every 6 h for 10 days and 19 patients 1 g phenoxymethylpenicillin every 12 h for 10 days. Tonsillar specimens were taken before and after antibiotic treatment. Tinidazole eliminated β-lactamase-producing Bacteroides strains in eight of nine patients. Five patients harboured β-lactamase-producing Staphylococcus aureus both before and after treatment. Clindamycin eradicated β-lactamase-producing Staph. aureus in nine of ten patients and Bacteroides strains in 10 of 14 patients. Penicillin failed to eliminate Staph . aureus in 11 patients. β-lactamase-producing Bacteroides strains were recovered in nine patients after therapy.