Treatments to reduce the discomfort from tonsillitis symptoms include:[2][3][4][5][13][18][19]
- pain relief, anti-inflammatory, fever reducing medications (paracetamol/acetaminophen and/or ibuprofen)
- sore throat relief (warm salt water gargle, lozenges, dissolved aspirin gargle (aspirin is an anti inflammatory, do not take any other anti inflammatory drugs with this method), and iced/cold liquids)
If the tonsillitis is caused by group A streptococcus, then antibiotics are useful with penicillin or amoxicillin being primary choices.[20] Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.[21] A macrolide such as erythromycin is used for people allergic to penicillin. Individuals who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria[22] such as clindamycin or amoxicillin-clavulanate. Aerobic and anaerobic beta lactamase producing bacteria that reside in the tonsillar tissues can "shield" group A streptococcus from penicillins.[23] When tonsillitis is caused by a virus, the length of illness depends on which virus is involved. Usually, a complete recovery is made within one week; however, symptoms may last for up to two weeks. Chronic cases may be treated withtonsillectomy (surgical removal of tonsils) as a choice for treatment.[24]
Prognosis[edit]
Since the advent of penicillin in the 1940s, a major preoccupation in the treatment of streptococcal tonsillitis has been the prevention of rheumatic fever, and its major effects on the nervous system (Sydenham's chorea) and heart. Recent evidence would suggest that the rheumatogenic strains of group A beta hemolytic strep have become markedly less prevalent and are now only present in small pockets such as in Salt Lake City.[25] This brings into question the rationale for treating tonsillitis as a means of preventing rheumatic fever.
Complications may rarely include dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection.[2][3][4][5][13]
An abscess may develop lateral to the tonsil during an infection, typically several days after the onset of tonsillitis. This is termed a peritonsillar abscess (or quinsy). Rarely, the infection may spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicaemia infection (Lemierre's syndrome).
In chronic/recurrent cases (generally defined as seven episodes of tonsillitis in the preceding year, five episodes in each of the preceding two years or three episodes in each of the preceding three years),[26][27][28] or in acute cases where the palatine tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils. Patients whose tonsils have been removed are still protected from infection by the rest of their immune system.
In strep throat, very rarely diseases like rheumatic fever[29] or glomerulonephritis[30] can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations.[31][32]