How do you get pharyngitis and tonsillitis? What is difference between pharyngitis and tonsillitis? How to get rid of pharyngitis and tonsillitis? Let’s find out about pharyngitis and tonsillitis diagnosis and treatment!
Table of Contents
Pharyngitis And Tonsillitis Meaning
Pharyngitis and tonsillitis definition – What are pharyngitis and tonsillitis? How to differentiate between pharyngitis and tonsillitis? Pharyngitis and tonsillitis are two infections that cause inflammation. When the tonsils are hurt, it is called tonsillitis. If the throat is affected, it’s called pharyngitis.
Pharyngitis and tonsillitis cause more than 10% of all visits to a primary care doctor’s office and 50% of all antibiotics given to people who are not in the hospital. So the most important thing is to figure out who is most likely to get a group A beta-hemolytic streptococcal (GABHS) infection, which can lead to problems like rheumatic fever and glomerulonephritis.
A second public health policy goal is to stop people from using antibiotics when they don’t need to. This wastes a lot of money and makes it more likely that S pneumoniae will become resistant to antibiotics.
People are asking questions like, “Have the rapid antigen tests made it so that most of the time you don’t need to culture a throat?” Do clinical criteria provide enough information to decide which patients should get antibiotics? Should anyone get an antibiotic besides penicillin (or erythromycin if they are allergic to penicillin)? How long should the treatment last?
A consensus has been reached based on the results of several well-done studies and the use of quick laboratory tests to find streptococci, which eliminates the delay caused by culture.
Pharyngitis And Tonsillitis Causes
What causes pharyngitis and tonsillitis? Pharyngitis and tonsillitis can be caused by viruses, fungi, bacteria, parasites, or smoking cigarettes. Viruses are responsible for most illnesses. Antibiotics can’t treat a viral infection, so they shouldn’t be used.
Pharyngitis And Tonsillitis Diagnosis
- Centor criteria: sore throat, fever, swollen lymph nodes in the front of the neck, and discharge from the tonsils. Throat pain.
- The goal is to treat a group A beta-hemolytic streptococcal infection so that rheumatic fever (rash, arthralgias, myocarditis) and other complications don’t happen later (glomerulonephritis, posterior pharyngeal abscess).
Pharyngitis And Tonsillitis Symptoms
Signs and symptoms of pharyngitis and tonsillitis – GABHS pharyngitis is most likely if you have a fever over 38°C, tender lymph nodes in the front of the neck, no cough, and pharyngotonsillar exudate. When these four things (the Centor criteria) are present, the person likely has GABHS.
There is a middle chance of GABHS when two or three of the four are present. GABHS is not likely when only one of the criteria is met. A sore throat can be very painful, with symptoms like odynophagia, tender lymph nodes, and a scarlatiniform rash. There is also the chance of a high white count and a left shift. This disease is not caused by a hoarse voice, a cough, or a rash.
If a young adult has swollen lymph nodes and a scaly, white-purple discharge from the tonsils that often goes into the nose and throat, this could be a sign of mononucleosis. With a sensitivity of about 90%, lymphocyte-to-white-blood-cell ratios of more than 35% indicate EBV infection instead of tonsillitis. Hepatosplenomegaly, a positive heterophile agglutination test, or a high anti-EBV titer are all signs that back up the diagnosis.
But about a third of people with infectious mononucleosis also get streptococcal tonsillitis, which needs to be treated. So if you think you have mononucleosis, you should avoid ampicillin because it can cause a rash that the patient might mistake for a penicillin allergy. Diphtheria is very rare, but it has been seen in alcoholics. It causes a low-grade fever and a gray membrane on the back of the throat.
Besides GABHS, viruses, Neisseria gonorrhoeae, Mycoplasma, and Chlamydia trachomatis, are the most common pathogens that can cause a sore throat. Rhinorrhea and no discharge would be signs of a virus, but in practice, it is impossible to tell a viral upper respiratory infection from GABHS just by looking at the patient.
Corynebacterium diphtheria, anaerobic streptococci, and Corynebacterium haemolyticum infections, which respond better to erythromycin than penicillin, can also look like GABHS-related pharyngitis.
Pharyngitis And Tonsillitis Treatment and Management at Home
Treatment of pharyngitis and tonsillitis – What is the best treatment for pharyngitis and tonsillitis?
The Infectious Diseases Society of America says that a throat culture or RADT of the throat swab should be done in the lab to confirm the clinical diagnosis. In collaboration with the Centers for Disease Control and Prevention, the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) recommends that adults with a high chance of having a streptococcal infection use a clinical algorithm instead of microbiologic testing to confirm the diagnosis.
Others look at the assumptions of the ACP-ASIM guideline for using a clinical algorithm alone and wonder if these recommendations will meet the stated goal of dramatically reducing antibiotics that aren’t needed.
Patients with zero or one Centor criterion have a very low risk of GABHS. Therefore, they don’t need throat cultures or RADT of the throat swab and shouldn’t get antibiotics either.
Patients who meet two or three Centor criteria need a throat culture or RADT of a swab from the back of the throat. If the results are positive, antibiotics will need to be given. Patients who meet all four of the Centor criteria are likely to have GABHS and can be treated without a throat culture or RADT. This is called “empirical therapy.”
A single intramuscular injection of 1.2 million units of either benzathine penicillin or procaine penicillin works well to treat an infection, but the injection hurts. So it is now used for patients who have trouble following an oral treatment plan.
At the moment, oral treatment works well and is preferred. Both penicillin V potassium (250 mg by mouth three times a day or 500 mg twice a day for 10 days) and cefuroxime axetil (250 mg by mouth twice daily for 5–10 days) work. With a 94% clinical response rate and an 84% streptococcal eradication rate, a 5-day course of penicillin V potassium seems to work just as well as a 10-day course. Erythromycin, which can also kill Mycoplasma and Chlamydia, is a good alternative to penicillin for people who are allergic to it.
Cephalosporins are a little better than penicillin when it comes to killing bacteria. For example, 5-day courses of cefpodoxime and cefuroxime have been successful. People have also said that shorter courses of the macrolide antibiotics work well. Due to its long half-life, Azithromycin (500 mg once a day) only needs to be taken for 3 days.
Scarlet fever, rheumatic myocarditis, glomerulonephritis, and the formation of a local abscess are all complications of streptococcal infections that are usually avoided with proper antibiotic treatment.
There are also mixed feelings about using antibiotics when a treatment doesn’t work. Surprisingly, penicillin-resistant strains are not found more often in people who do not respond to treatment than in people who do respond to treatment with penicillin. There seems to be more than one reason why the treatment didn’t work, so it makes sense to try the same drug again.
Cefuroxime and other cephalosporins, dicloxacillin (resistant to beta-lactamases), and amoxicillin with clavulanate are all alternatives to penicillin. When there is a history of an allergy to penicillin, other medicines, such as erythromycin, should be used instead. With about a 25% failure rate, erythromycin resistance is becoming more of a problem in many places. If you have a severe penicillin allergy, you should not take cephalosporins because they can cause a cross-reaction in more than 8% of cases.
Aspirin, acetaminophen, and corticosteroids are pain relievers and anti-inflammatory drugs that can be used to treat pharyngitis. In a meta-analysis, corticosteroids made it three times more likely that the pain would be gone after 24 hours without making it more likely that the pain would come back or those bad things would happen.
Some people find that gargling with salt water is soothing. In severe cases, gargles and lozenges with anesthetics (like benzocaine) may help relieve symptoms even more. Sometimes odynophagia is so bad that it needs to be treated in the hospital with intravenous fluids and antibiotics.
Patients with rheumatic fever should take antimicrobial prophylaxis (either 500 mg of penicillin G once a day or 250 mg twice daily of erythromycin) for at least 5 years.
I hope you understand pharyngitis and tonsillitis diagnosis and treatment guidelines.