Tonsillitis (Tonsils Inflammation): Drug Therapy

Therapeutic targets

  • Elimination of the pathogens
  • Avoidance of complications

Therapy recommendations

  • Diagnostic procedure or treatment decision in patients aged 3 to 14 years and (suspected of) tonsillitis/tonsillopharyngitis with the aid of the McIsaac score (see “Physical examination” below):
    • McIsaac score 3-5 points: GABHS tonsillitis (GABHS = group A beta-hemolytic streptococci) more likely; if relevant for decision: throat swab for microbiological culture or rapid test; positive test → antibiosis.
    • McIsaac score -1-2 points:viral tonsillitis more likely:
      • If spontaneous course is favorable → no diagnosis.
      • In the absence of spontaneous emission, relevant disease severe or unilateral findings microbiological diagnostics.
  • Diagnostic procedure or treatment decision in patients aged ≥ 15 years and (suspected) tonsillitis / tonsillopharyngitis with the aid of the McIsaac score (see below “Physical examination”):
    • McIsaac score 3-4 points: GABHS tonsillitis more likely; if relevant to decision: throat swab for microbiologic culture or rapid test; → antibiotic treatment.
    • McIsaac score 0-2 points:viral tonsillitis more likely:
      • If spontaneous course is favorable → no diagnosis.
      • In the absence of spontaneous emission, relevant disease severe or unilateral findings microbiological diagnostics.
  • Antibiotic therapy requires the detection or urgent suspicion of the presence of β-hemoylating streptococcal tonsillopharyngitis! After exclusion of tonsillopharyngitis due to β-hemoylating streptococci group A, C, or G, antibiotic therapy is usually not useful. Therapy usually with penicillin V; in case of penicillin intolerance: cefadroxil or erythromycinOnly for certain other, now very rare pathogens (eg, Corynebacterium diphtheriae), the benefit of antibiotic therapy is unquestionable.
  • Duration of antibiotic therapy: 5-7 days (depending on the agent); review antibiotic therapy after 3 to 4 days to determine if therapy is responding.
  • Symptomatic therapy:non-steroidal anti-inflammatory drugs: e.g. ibuprofen or paracetamol, daily for 2 (-3) days.

Notice. Acetylsalicylic acid (ASA) must not be used in children under 12 years of age, otherwise a life-threatening complication – the so-called Reye syndrome – may occur. This condition is associated with brain and liver damage and is life-threatening for affected children.

Supplements (dietary supplements; vital substances)

Suitable dietary supplements for natural defense should contain the following vital substances:

Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.