Significance of etiological diagnosis
Determining the nature of the pathogen (virus or bacterium, specifically identifying group A beta-hemolytic streptococcus) determines all further patient management tactics. In confirmed streptococcal tonsillopharyngitis, the prescription of antibacterial agents is mandatory. If the process is of viral origin, antibiotics are not indicated, as the disease resolves spontaneously within one to two weeks.
Selection of antibacterial drugs
The main drugs for treating streptococcal tonsillitis remain beta-lactams (penicillins). All strains of S. pyogenes retain one hundred percent susceptibility to them, which is confirmed by the high clinical efficacy of therapy in acute tonsillitis.
In situations where the use of beta-lactams is impossible, alternative agents are prescribed:
- Lincosamides (specifically, clindamycin), characterized by a low level of microflora resistance (about 3-4%).
- Macrolides and tetracyclines are used with caution, as the resistance rate to them remains significant (approximately 20% and 13–22% respectively).
Errors in patient management tactics
The detection of concomitant or colonizing flora, such as S. aureus or S. pneumoniae, on the oropharyngeal mucosa in the presence of clinical symptoms of acute tonsillopharyngitis is not an indication for initiating antibacterial therapy. Understanding this fundamental point effectively avoids the unjustified prescription of antibiotics.
Penicillins — 100% victory over streptococcus, lincosamides — a reliable backup in case of allergy, and macrolides require resistance testing (20%).
Class and exam questions
Is it necessary to prescribe antibiotics for viral tonsillitis?
No, in a viral process, antibacterial therapy is not indicated, as the disease resolves spontaneously within one to two weeks.
Which drugs are the drugs of choice in streptococcal tonsillitis?
Beta-lactams (penicillins) remain the drugs of choice, maintaining one hundred percent susceptibility across all streptococcus strains.
Is the detection of S. aureus on the mucosa an indication for antibiotics?
No, the detection of colonizing flora like S. aureus or S. pneumoniae does not require the prescription of antibacterial therapy.
What else to study on this topic
- Acute poststreptococcal glomerulonephritis
- Esophagitis
- Etiology and pathogenesis of tonsillitis
- Non-streptococcal acute glomerulonephritis
- Prevention of erysipelas relapses and benzathine benzylpenicillin prophylaxis
- Infectious mononucleosis and features of its therapy
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