Antibiotics for recurrent acute pharyngo-tonsillitis: systematic review

Abstract

The purpose was to determine the current evidence for preferable antibiotic treatment in three common clinical situations with insufficient consensus: Q1: Can antibiotic treatment prevent future attacks of acute pharyngo-tonsillitis (APT) in patients with recurrent APT (RAPT)? Q2: Which antibiotic regimen is preferable in the treatment of APT in patients with RAPT? Q3: Which antibiotic regimen is preferable in the treatment of relapsing APT? Five databases were searched systematically for randomized clinical trials on patients with RAPT with or without current APT or with relapse of APT. Of the unique publications, 643 were found. Five studies addressing Q1 (n = 3) and Q2 (n = 2) met the eligibility criteria. No studies reporting on Q3 were included. Q1: Two studies found that clindamycin and cefpodoxime, respectively, were effective in preventing future APT episodes and in eradicating group A streptococci from the tonsils of RAPT patients. One study found that long-term azithromycin had no effect on the number of APT episodes. Q2: Two studies reported superior clinical and microbiological effects of clindamycin and amoxicillin with clavulanate, respectively, compared to penicillin. The four studies showing superior effects of clindamycin and amoxicillin with clavulanate were assessed to have high risk of bias. Hence, the level of evidence was moderate. There is considerable evidence to suggest that clindamycin and amoxicillin with clavulanate are superior to penicillin with preferable effects on the microbiological flora and the number of future attacks of APT in patients with RAPT. Antibiotic treatment is an option in patients with RAPT, who has contraindications for tonsillectomy.

Effects of Osteopathic T9–T10 Vertebral Manipulation in Tonsillitis: A Randomized Clinical Trial

“…Several studies on tonsillitis describe a decrease of 0.5 to 1 episode on average in the subsequent year of follow-up in the control group, as shown in a recent clinical practice guideline [2]. In a study with children and adults, the placebo group obtained 51% of the cases without relapses in the following year [4,54], although in our CG there was a 22.5% of cases without relapses. In our sample, the considerable decrease in post-intervention episodes in CG led us to think that there could be a strong placebo component in both study groups [55][56][57].…”

“…In our sample, the considerable decrease in post-intervention episodes in CG led us to think that there could be a strong placebo component in both study groups [55][56][57]. In one pediatric study about prophylaxis with cefpodoxime versus placebo [4,58], the number of acute episodes at 12 months was reduced by 84% in the intervention group compared to 15% in the placebo group. In our sample, the reduction in the number of episodes of CG infants was much greater (64% fewer episodes, versus 83% reduction in OMG).…”

“…Palatal tonsillitis, either acute, recurrent or chronic, is a relatively common disease [1], especially in childhood [1,2]. The treatment of choice is the use of nonsteroidal antiinflammatory drugs (NSAIDs) and/or antibiotics [1,3,4], and in some cases tonsillectomy [5][6][7][8][9]. These treatments can present side effects [5,6,[10][11][12][13] in the short and long term [14].…”

Antibiotics in treatment of peritonsillar infection: clindamycin versus penicillin

“…A possible reason for this difference in characteristics is that it has been shown that clindamycin reduces the number of recurrent tonsillitis cases, leading to national Swedish clinical guidelines supporting clindamycin as the primary treatment for recurrent tonsillitis. 33,34 It is reasonable to assume that this sometimes affects the doctor's choice of antibiotics when treating peritonsillar infection as well. To our knowledge, it has not been shown that clindamycin reduces the number of recurrent cases of peritonsillar infection, and in this study we found no difference in such recurrence.…”

Эффективность применения респираторного пробиотика Streptococcus salivarius K12 у детей с рекуррентными тонзиллитами

“…Среди Streptococcus pyogenes -единственный возбудитель, при выделении которого показано назначение антибактериальной терапии у детей с РТ [8,14]. Однако рост в последние годы резистентности микроорганизма ко многим антибиотикам является одной из основных причин неэффективности терапии РТ, что в конечном итоге приводит к более частой хронизации патологического процесса и развитию осложнений со стороны внутренних органов [4,7].…”