By Dr Ananya Mandal, MD
Tonsillitis is usually caused by viruses and therefore the use of antibiotics is generally not effective in treating the infection. Treatment is usally aimed at alleviating symptoms, preventing secondary bacterial infections and preventing recurrence. Symptoms such as inflammation, pain and redness usually resolve within a week.
Some of the approaches to managing tonsillitis include:
Pain relief and fever reduction
This is mainly achieved through the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and paracetamol. Aspirin should be avoided as it can cause a dangerous condition called Reye's syndrome that damages the liver and brain.
Lozenges can also help to relieve a sore throat, a cough and difficulty swallowing. Lozenges that relieve these symptoms contain substances such as lidocaine, bezocaine, benzydamine and flubiprofen.
Gargling with a solution of warm water and salt can also reduce pain and swelling.
Patients should be encouraged to take complete bed rest and plenty of clear fluids.
Antibiotics are prescribed if the tonsillitis is found to be caused by bacteria. Penicillin, erythromycin and clarithromycin are commonly used to treat bacterial tonsillitis. Due to emerging antibiotic resistance, the usual practice is to identify the exact strain and type of bacteria as well as the bacteria's sensitivity to antibiotics prior to prescribing an antibiotic.
Antibiotics may be prescribed when symptoms do not subside after four days, to prevent secondary bacterial infection.
Surgical removal of tonsil or tonsillectomy
Tonsillectomy is a routine surgical procedure that is safe and effective. It is usually recommended in cases of recurrent tonsillitis. Tonsillectomy is performed after the active infection has subsided.
A patient is given general anesthesia and the tonsils are surgicaly removed while pressure is applied to control bleeding. The tonsils may be excised using a blade, or a specialized tool that the destroys tissue with high-energy heat waves or laser beams.
The patient is usually allowed to leave the hospital on the same day of the operation and is asked to report back in cases of any complications such as bleeding, infection or pain. The pain usually resolves after two weeks. Ear pain and difficulty swallowing are common side effects of the operation.
Reviewed by Sally Robertson, BSc