Tonsillitis and pharyngitis

J03.0/J03.8-9/J35.0/J02.0/J02.8-9/J31.1-2

DESCRIPTION

A painful red throat and/or enlarged inflamed tonsils. White pus exudates, either spots or patches, may be present. Tender anterior cervical lymphadenopathy may be present.
Viruses cause the majority of cases. Group A beta haemolytic streptococcus causes 20% of pharyngitis/tonsillitis, and may result in rheumatic fever (which can cause serious heart disease) as well as local suppurative complications.
Other clinical features that might suggest streptococcal infection may include palatal petechiae, inflamed tongue mucosal papillae (strawberry tongue), a scarlitiniform (i.e.: rough, diffuse, fine papular) rash.

GENERAL MEASURES

  • Homemade salt mouthwash, gargle for 1 minute twice daily:
    • 2.5 mL (½ medicine measure) of table salt in 200 mL lukewarm water.
    • Do not give to children unable to gargle.
  • Advise adequate hydration.
  • Avoid irritants e.g. vaporubs inserted into nostrils.
  • For children < 6 years of age: Soothe the throat with, breastmilk. If not exclusively breastfed, give warm water or weak tea: add sugar or honey and lemon if available.

MEDICINE TREATMENT

Antibiotics are not required for all patients with a sore throat.

Antibiotics to eradicate streptococci must be given to patients presenting with a sore throat who are at risk for rheumatic fever (3–21 years of age) if they have:

  • Enlarged tonsils;
  • PLUS at least one of the following criteria:
    • Exudates on their tonsils
    • No cough
    • No runny nose

LoEI [14]

  • Benzathine benzylpenicillin, IM, single dose.
    • Children < 30 kg: 600 000 IU.
    • Children ≥ 30 kg and adults: 1.2 MU.
    • Dissolve benzathine benzylpenicillin 1.2 MU in 3.2 mL lidocaine 1% without adrenaline (epinephrine) or 3 mL water for injection.

OR

Children

  • Amoxicillin, oral, 50 mg/kg daily for 10 days.

tonsillitus and pharyngitis Medicine treatment.png

LoEI [15]

Adults

  • Amoxicillin, oral, 1 000 mg 12 hourly for 10 days.

LoEIII [16]

OR

Children: 18 months–11 years of age

  • Phenoxymethylpenicillin, oral, 250 mg 12 hourly for 10 days.

Children > 11 years of age and adults

  • Phenoxymethylpenicillin, oral, 500 mg 12 hourly for 10 days.

Severe penicillin allergy: (Z88.0)

Children > 3 years of age

Children > 35 kg and adults

  • Macrolide, e.g.:
  • Azithromycin, oral, 500 mg daily for 3 days.

Pain:

Children

Adults

  • Paracetamol, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

REFERRAL

  • Any suppurative complications, e.g. retropharyngeal or peritonsillar abscess.
  • Tonsillitis accompanied by difficulty in opening the mouth (trismus).
  • Recurrent tonsillitis (≥ 6 documented episodes/year) for possible tonsillectomy.
  • Suspected acute rheumatic fever.
  • Suspected acute glomerulonephritis.
  • Heart murmurs not previously diagnosed.