1

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Tonsillitis
Tonsillitis is an inflammation of the tonsils most commonly caused by viral or bacterial infection. Symptoms of tonsillitis include sore throat and fever. While no treatment has been found to shorten the duration of tonsillitis, bacterial causes are treatable with antibiotics. viral

CAUSES:
microbiological point of view: The most common causes of tonsillitis are the common cold viruses (adenovirus, rhinovirus, influenza, coronavirus, respiratory syncytial virus). It can also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. The second most common causes are bacterial. The most common bacterial cause is Group A -hemolytic streptococcus (GABHS), which causes strep throat. Less common bacterial causes include: Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea mechanism of action Under normal circumstances, as viruses and bacteria enter the body through the nose and mouth, they are filtered in the tonsils. Within the tonsils, white blood cells of the immune system mount an attack that helps destroy the viruses or bacteria, and also causes inflammation and fever The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. This is the area in the back of the throat that lies between the voice box and the tonsils.

Symptoms: Common symptoms of tonsillitis include:

red and/or swollen tonsils white or yellow patches on the tonsils tender, stiff, and/or swollen neck sore throat painful or difficult swallowing cough headache sore eyes body aches earache fever

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* chills nasal congestions Acute tonsillitis is caused by both bacteria and viruses and will be accompanied by symptoms of ear pain when swallowing, bad breath, sore throat and fever. In this case, the surface of the tonsil may be bright red or have a grayish-white coating, while the lymph nodes in the neck may be swollen. Tonsilloliths occur in up to 10% of the population frequently due to episodes of tonsillitis.

Treatment:
Pharmacological point of view:
Treatments to reduce the discomfort from tonsillitis symptoms include pain relief, anti-inflammatory, fever reducing medications (acetaminophen/paracetamol and/or ibuprofen) reyes syndrome paracetamol

sore throat relief (salt water gargle, lozenges, warm liquids) If the tonsillitis is caused by group A streptococus, then antibiotics are useful with penicillin or amoxicillin being first line. A macrolide such as erythromycin is used for patients allergic to penicillin. Patients who fail penicillin therapy may respond to treatment effective against beta-lactamase producing bacteria 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. 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 may last for up to two weeks. Chronic cases may be treated with tonsillectomy (surgical removal of tonsils) as a choice for treatment. 1. pain relief, anti-inflammatory, fever reducing medication A: acetaminophen /paracetamol mechanism of action: cox3 inhibitor act as analgesic & antipyretic no anti-inflammatory effect central effect is> preferable effect (cox3 is isoform of cox 2 but in brain) 3

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

paracetamol

cetal 100dps,120supp, 250syr,500tab

panadol 500,oblong, actifast, extra

abimol150,300

adol cap,adol extra tab

pyral 100dps,120syr, 250supp ,500tab

paramol 120syr, 125supp 500tab

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

caffien extra B: ibuprofen mechanism of action: has anti inflamatory activity more potent can replace all NSAIDS in use

Ibuprofen

Profen 200/400/600

2:antibiotic A:Penicillin or amoxacillin

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

mechanism of action:
irreversible inhibitor of transpeptidase enzyme which is responsible for peptidoglycan cross linking in cell wall which decrease cell wall regidity &increase H2O permeability cause swelling & lysis rapid & potent bactericidal

retarpen vial

durapen vial

penicid vial

pencitard vial

ospen 100, 1500 tab,

susp

ampicillin ,125,250,500(
susp,cap,vial)

amoxil125 250,500
susp 250,500vial

hiconcil125susp
250,500susp,cap

B: macrolides erythromycin & erythromycin stearate 250,500 alternative for penicillins in penicillin allergy patient mechnism of action: bacteriostatic but may be bacteriocidal at high dose bind to 50s sub unit of bacterial ribosmes &inhibit protein synthesis by interfering with translocation of amino acyl t-RNA&formation of initiation complex

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* accumulate in leukocytes &thus,transfer to site of infection

erythromycin

C:clindamycin (macrolides combination) : alternative for people who fail penicillin as it is active against beta_lactamase producing bacteria more active than erythromycin

mechanism of action:
act as bactericidal & bacteriostatic Semi-synthetic antibiotic that suppresses protein synthesis

clindam 150,300

dalacin c 150,300

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

D:Amoxacillin _clavulanate alternative for people who fail penicillin as it is active against beta_lactamase producing bacteria

mechnism of action:
Irreversible inhibition of beta lactamase enzyme. suicidal inhibition.

clavulanic

amoxicillin

Ampiclox 250 syr 500vial cap

Augmantin 375 ,625,1000 tab 600,1200

Curam 625,1000

Hibiotic 375,625, 1000 tab 230,460 susp

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.*

Advice to patients:

complications:
Complications may rarely include 1. 2. 3. 4. dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection. 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), 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 very rare cases of strep throat, diseases like rheumatic fever or glomerulonephritis can occur. These complications are extremely rare in developed nations but remain a significant problem in poorer nations. Tonsillitis associated with strep throat, if untreated, is hypothesized to lead to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

5.

6.

References:
pharmaceutical chemestery 4th year 2nd term

*this material is free to be used in any educational procedure, downloaded , copied or shared once used without any content modification.* http://sehha.com/index.shtml http://en.wikipedia.org/