tonsillopharyngitis%20-%20acute%20(pediatric)
TONSILLOPHARYNGITIS - ACUTE (PEDIATRIC)
Tonsillopharyngitis is the inflammation of the tonsils and pharynx.
Etiologies include bacterial and viral pathogens.
Sore throat is the most common presenting symptom in older children.

Principles of Therapy

Symptomatic Treatment - Non Group A Beta-hemolytic Streptococcus (GABHS) infection
  • Symptomatic treatment is important in the management of children with sore throat
Symptomatic Treatment - Group A Beta-hemolytic Streptococcus (GABHS) infection
  • Important in the management of children with sore throat
  • Same as for non-GABHS infection
Antimicrobial Therapy
  • Treatment started only for documented GABHS infection
  • Due to practical constraints, antibiotics may be started empirically if:
    • GABHS is clinically suspected
    • Patient is toxic-looking
    • Follow-up is not possible
  • Empiric treatment of GABHS is discouraged due to poor diagnostic accuracy even with elaborate clinical scoring systems
  • A rapid antigen detection test (RADT) or throat swab should be taken before starting empiric antibiotics
  • If antibiotics are started empirically, & culture results are negative, the antibiotic should be discontinued
  • Appropriate antibiotics prevent acute rheumatic fever (ARF), prevent suppurative complications, decrease infectivity & shorten clinical course

Pharmacotherapy

Non-group A beta-hemolytic Streptococcus (Non-GABHS)

Simple Analgesics / Antipyretics
  • Paracetamol is the drug of choice for analgesia in sore throat
  • Aspirin is not recommended due to the risk of Reye’s syndrome
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
  • Ibuprofen is a safe & effective alternative for analgesia & antipyrexia
  • Diclofenac may also be used for against pain caused by acute tonsillopharyngitis (ATP)
  • As NSAIDs are associated with significant risk of gastrointestinal bleeding (GI) bleeding, their routine use is not recommended
Throat Lozenges/Gargle/Spray
  • May be helpful especially in those with significant throat pain or discomfort
Group A beta-hemolytic Streptococcus (GABHS)

Penicillin
  • Drug of choice
  • Proven efficacy, narrow spectrum, safety & low cost
  • Full 10-day course of treatment for oral medications
  • Intramuscular (IM) penicillin may be advisable if poor compliance is a concern
Amoxicillin
  • Better tolerated than Penicillin
  • 2nd line to Penicillin in pediatric patients due to taste preference
Macrolides
  • Eg Azithromycin, Clarithromycin, Erythromycin
  • May be used for patients with Penicillin allergy
  • Local resistance patterns should be included in the consideration for an alternative antibiotic in Penicillin-allergic patients
    • Resistance rate in Taiwan is approximately 10%
  • Azithromycin or Cephalexin may be used for Erythromycin-intolerant patients
Cephalosporins
  • Eg Cefaclor, Cefadroxil, Cefdinir, Cefixime, Cefpodoxime, Cephalexin
  • Alternative to Amoxicillin for the eradication of streptococcal infection especially in recurrent cases
  • Studies show that a 5-day treatment with a cephalosporin is superior to a 10-day course with Penicillin
Clindamycin
  • May be used for those who are both Penicillin-allergic & Erythromycin-intolerant
    • Resistance rate in Taiwan is approximately 10%
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
24 Oct 2018
Antibiotics has been administered unnecessarily to as many as one-third of children with respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI) in hospitals in the Netherlands and Israel, according to a prospective international multicentre RSV study using an expert panel as reference standard to identify children with and without bacterial coinfection.
Jairia Dela Cruz, 24 Oct 2018
A 12-item prognostic tool touts good predictive ability for identifying adolescents likely to initiate smoking over a 1-year period, as reported in a recent study from Canada.
02 Dec 2018
Antibiotic therapy in preterm, very low birth weight (VLBW) infants within the first 14 postnatal days increases the risk of subsequent late-onset sepsis, necrotizing enterocolitis (NEC) or death, a recent study has shown.
01 Dec 2018
In children, the incidence rate of hyponatraemia differs according to the respiratory tract infection and the invading microorganism, a recent study has shown.