my five year-old daughter was diagnosed as having tonsilitis four days ago and prescribed antibiotics. We prefer not to give the children antibiotics unless they are very ill and so have treated her with paracetamol to reduce fever and swelling and with homeopathic remedies. She continues to be be tired and lethagic, with a raised temperature which makes her feel hot and cold simultaneously, but our main concern is that the back of her neck, rather than her throat, is very sore, which causes her to hunch her shoulders up. Our doctor's reluctance to consider any treatment other that antibiotics makes it difficult for us to ask for advice about the sore neck or about other ways of making her more comfortable while she feels so unwell.
Reply: --------------------
I frankly cannot condone nor recommend alternative treatments for bacterial tonsillitis in a child that is associated with febrile illness other than antibiotics. It is potentially dangerous to withold antibiotics in a child with streptococcal tonsillitis as it could lead to serious complication such as a kidney condition known as post-streptococcal glomerulonephritis or a heart condition known as rheumatic fever.
On the other hand, it is my opinion that antibiotics are used far to often in the treatment of throat infections since many throat infections are not bacterial, but rather viral. One step in the right direction in addressing the problem of over-reliance on antibiotics in our society is to be more disciplined in the treatment of throat infections. Antibiotic therapy for sore throats should be limited to bacterial infection. Bacterial tonsillitis is usually a febrile illness with fever greater than 101-2 degrees F and associated with significant malaise in addition to sore throat. There are usually no major nasal symptoms. Muscle discomfort anywhere in the body including the neck muscles is not uncommon. Provided the illness has these characteristics, antibiotic therapy may be considered but should still be based on culture of the throat or what is known as a rapid strep screen whenever possible. For example, if one comes into my office with the symptoms mentioned, I will often start the patient on enough antibiotics until the results of a throat culture are available - if the culture is positive then I will have the patient remain on antibiotics for 7-10 days. If it is negative, antibiotics are discontinued and supportive care instituted. Supportive care is directed towards treatment of the bothersome symptoms. The sore throat may be improved with lozenges or Cepastat spray. Sometimes warm dilute salt water gargles are helpful. The muscle aches are usually best treated with non-steroidal anti-inflammatory medications such as ibuprofen. Moist heat to the affected areas may also be helpful.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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