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INFEKTOLOGIJA

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20110517

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INFEKTOLOGIJA




Tonsillitis


Sore throat and temperature Membrane over the tonsils and enlarged and sore lymph glands
General symptoms (headache, abdominal pain particularly in children, nausea, and vomiting)
rapid onset of symptoms
Cough and rhinitis are evidence against group A streptococcal infection
Aetiology of tonsillitis
significant causative agents:
beta-haemolytic streptococci (groups A, C and G)
adenoviruses
Epstein-Barr virus
other causative agents:
various bacteria and viruses which are rare and with little significance on treatment


Diagnosis of tonsillitis
Group A streptococcal infection cannot be reliably diagnosed on clinical symptoms and findings
Antibiotic treatment should be based on isolation of beta-haemolytic streptococci from the throat
The main bacteriological investigation is a throat swab (the only acceptable one during an epidemic)
Use of “on the spot” testing methods is justifiable only if results are available whilst the patient waits
a positive “on the spot” test result is reliable – a negative one should be counterchecked by bacterial culture


Antimicrobial therapy of tonsillitis
First choice:
Penicillin V 1-1.5 mega units twice daily for 10 days (more relapses with shorter treatment period (A))
Second choice:
first generation cephalosporins (cefalexin 750 mg twice daily or cefadroxil 1g daily) or
procaine penicillin 1.2 – 1.5 mega units daily
for 10 days
macrolides – with caution (if local resistance patterns accept their use or they are indicated by sensitivity testing)

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