Tonsillopharyngitis

Tonsillopharyngitis is acute infection of the pharynx, palatine tonsils, or both. Symptoms may include sore throat, dysphagia, cervical

lymphadenopathy, and fever. Diagnosis is clinical, supplemented by culture or rapid antigen test. Treatment depends on symptoms and, in

the case of group A β-hemolytic streptococcus, involves antibiotics.

Etiology

The tonsils participate in systemic immune surveillance. In addition, local tonsillar defenses include a lining of antigen-processing

squamous epithelium that involves B- and T-cell responses.

Tonsillopharyngitis of all varieties constitutes about 15% of all office visits to primary care physicians.

Etiology

Tonsillopharyngitis is usually viral, most often caused by the common cold viruses (adenovirus, rhinovirus, influenza, coronavirus,

respiratory syncytial virus), but occasionally by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV.

In about 30% of patients, the cause is bacterial. Group A β-hemolytic streptococcus (GABHS) is most common (see Gram-Positive Cocci:

Streptococcal Diseases), but Staphylococcus aureus, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae

are sometimes involved. Rare causes include pertussis, Fusobacterium, diphtheria, syphilis, and gonorrhea.

GABHS occurs most commonly between ages 5 and 15 and is uncommon before age 3.

Symptoms and Signs

Pain with swallowing is the hallmark and is often referred to the ears. Very young children who are not able to complain of sore throat

often refuse to eat. High fever, malaise, headache, and GI upset are common, as are halitosis and a muffled voice. A scarlatiniform or

nonspecific rash may also be present. The tonsils are swollen and red and often have purulent exudates. Tender cervical lymphadenopathy

may be present. Fever, adenopathy, palatal petechiae, and exudates are somewhat more common with GABHS than with viral

tonsillopharyngitis, but there is much overlap. GABHS usually resolves within 7 days. Untreated GABHS may lead to local suppurative

complications (eg, peritonsillar abscess or cellulitis) and sometimes to rheumatic fever or glomerulonephritis.

Diagnosis
• Clinical evaluation
• GABHS ruled out by rapid antigen test, culture, or both

Pharyngitis itself is easily recognized clinically. However, its cause is not. Rhinorrhea and cough usually indicate a viral cause. Infectious

mononucleosis is suggested by posterior cervical or generalized adenopathy, hepatosplenomegaly, fatigue, and malaise for > 1 wk; a full

neck with petechiae of the soft palate; and thick tonsillar exudates. A dirty gray, thick, tough membrane that bleeds if peeled away
indicates diphtheria (rare in the US).

Because GABHS requires antibiotics, it must be diagnosed early. Criteria for testing are controversial. Many authorities recommend testing

with a rapid antigen test or culture for all children. Rapid antigen tests are specific but not sensitive and may need to be followed by a

culture, which is about 90% specific and 90% sensitive. In adults, many authorities recommend using the following 4 criteria:

• History of fever

• Tonsillar exudates
• Absence of cough

• Tender anterior cervical lymphadenopathy

Patients who meet 1 or no criteria are unlikely to have GABHS and should not be tested. Patients who meet 2 criteria can be tested.

Patients who meet 3 or 4 criteria can be tested or treated empirically for GABHS.

Treatment
• Symptomatic treatment
• Antibiotics for GABHS
• Tonsillectomy considered for recurrent GABHS

Supportive treatments include analgesia, hydration, and rest. Penicillin V is usually considered the drug of choice for GABHS

tonsillopharyngitis; dose is 250 mg po bid for 10 days for patients < 27 kg and 500 mg for those> 27 kg (see also Gram-Positive Cocci:

Pharyngitis). Amoxicillin is effective and more palatable if a liquid preparation is required. If compliance is a concern, a single dose of

benzathine penicillin 1.2 million units IM (600,000 units for children ≤ 27 kg) is effective. Other oral drugs include macrolides for patients

allergic to penicillin, a 1st-generation cephalosporin, and clindamycin

Treatment may be started immediately or delayed until culture results are known. If treatment is started presumptively, it should be stopped

if cultures are negative. Follow-up throat cultures are not done routinely. They are useful in patients with multiple GABHS recurrences or

if pharyngitis spreads to close contacts at home or school.

Tonsillectomy: Tonsillectomy should be considered if GABHS tonsillitis recurs repeatedly (> 6 episodes/yr, > 4 episodes/yr for 2 yr, > 3

episodes/yr for 3 yr) or if acute infection is severe and persistent despite antibiotics. Other criteria for tonsillectomy include obstructive

sleep disorder, recurrent peritonsillar abscess, and suspicion of cancer.

Numerous effective surgical techniques are used to perform tonsillectomy, including electrocautery, microdebrider, radiofrequency
coblation, and sharp dissection. Significant intraoperative or postoperative bleeding occurs in < 2% of patients, usually within 24 h of
surgery or after 7 days, when the eschar detaches. Patients with bleeding should go to the hospital. If bleeding continues on arrival, patients
generally are examined in the operating room, and hemostasis is obtained. Any clot present in the tonsillar fossa is removed, and patients
are observed for 24 h. Postoperative IV rehydration is necessary in ≤ 3% of patients, possibly in fewer patients with use of optimal
preoperative hydration, perioperative antibiotics, analgesics, and corticosteroids. Postoperative airway obstruction occurs most frequently
in children < 2 yr who have preexisting severe obstructive sleep disorders and in patients who are morbidly obese or have neurologic
disorders, craniofacial anomalies, or significant preoperative obstructive sleep apnea. Complications are generally more common and
serious among adults.

Lifestyle and home remedies

A sore throat can make you miserable. These tips can help.

 Drink more fluids. Warm liquids — such as soup, broth and tea — are good choices.

 Gargle with warm salt water. Mix 1/4 teaspoon of salt in 8 ounces of warm water, gargle, and then spit out the water.

 Use honey and lemon. Stir honey and lemon to taste into a glass of hot water. Allow it to cool to room temperature before
 you sip it. The honey coats and soothes your throat, and the lemon helps reduce mucus. Don't use honey or corn syrup in a
drink for children younger than age 1.

 Suck on a throat lozenge or hard candy. This stimulates saliva production, which bathes and cleanses your throat.

 Humidify the air. Adding moisture to the air can reduce throat irritation and make it easier to sleep. Be sure to change the
water in a room humidifier daily and clean the unit at least once every three days to help prevent the growth of harmful molds
and bacteria.

 Avoid smoke and other air pollutants. Smoke irritates a sore throat.

 Rest your voice. Talking may lead to more throat irritation and temporary loss of your voice (laryngitis).

Hidrasec® [powd]
MIMS Class :Antidiarrheals

Indications Cap Treatment of acute diarrhea. Powd Adjunct to oral or parenteral rehydration in the treatment of acute watery diarrhea in
infants & childn.
Dosage Cap Adult 100 mg. Further treatment: 8 hrly until cessation of diarrhea. Powd Childn & infants 1.5 mg/kg/dose, w/ 1 initial
dose & 3 daily divided doses.
Administration May be taken with or without food

Contraindications
Special Precautions
Adverse Drug Reactions
Powd Renal or hepatic impairment. Fructose intolerance, glucose & galactose malabsorption syndrome or sucrase isomaltase
deficiency.
Rehydration. Consider severe or prolonged diarrhea, maintain feeding during diarrhea, severe vomiting, refusal of food.
Childn >24 mth. Pregnancy, lactation.
Drowsiness, nausea & vomiting, constipation, dizziness, headache.

MIMS Class Antidiarrheals

ATC Classification A07XA04 - Racecadotril ; Belongs to the class of other preparations used in the treatment of diarrhea.
Action Racecadotril is an antidiarrheal drug which acts as a peripherally acting enkephalinase inhibitor.[1] Unlike other medications used to treat diarrhea, which
reduce intestinal motility, racecadotril has an antisecretory effect—it reduces the secretion of water and electrolytes into the intestine.[