Can erythromycin cure a sore throat
Reluctance to use surgery and antibiotics
The authors see an urgent need for research to better assess the value of tonsillectomy. In any case, the procedure is not without risk. Disadvantages are, for example, the postoperative pain and the risk of rebleeding. In these matters, partial removal of the tonsils (tonsillotomy) does better. It has not yet been researched whether this operation, which is only possible from a certain size of the tonsils and which is currently performed much less frequently than total removal, achieves such favorable results that it could represent an alternative.
Viral or bacterial?
In order to differentiate viral from bacterial acute tonsillitis, the guideline recommends the McIsaac or modified Centor score. Various factors such as fever, cough, lymph node swelling and age are rated with points, the sum of which makes a statement about the likelihood of bacterial genesis. A throat swab for detection of GABHS should only be taken from a certain number of points. Blood and urine tests, for example to determine the antistreptolysin (ASL) titer, are unnecessary.
The guideline authors emphasize that acute, non-obstructive tonsillitis usually heals on its own, even if it is caused by GABHS. Nonetheless, antibiotics are often given, not least because parents of affected children so wish. "In order to avoid the non-indicated use of antibiotics, it is necessary to consider the patient or parents' desire for symptom relief separately from the rational medical considerations for or against antibiotic therapy," it says succinctly.
The advantages of antibiotic therapy - reducing the duration of symptoms and the ability to become infected, avoiding possible immunological sequelae - are offset by the disadvantages of the side effects, the possible development of resistance and the costs. If antibiotic therapy is indicated, this should be done with an oral penicillin for seven days, for example with penicillin V. Alternatives are oral cephalosporins with a narrow spectrum of activity and erythromycin or clindamycin.
Paracetamol or ibuprofen can be used to relieve symptoms. Local anesthetics and local antiseptics in the form of throat sprays, lozenges and gargle solution, on the other hand, have so far not shown any reliable effect. If the inflamed tonsils threaten to block the upper airways, steroids can be given to reduce swelling. The benefit of acyclovir in acute tonsillitis caused by the Epstein-Barr virus could not be proven in meta-analyzes. /
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