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Pneumococcal tonsillitis — Clinical Guidelines

Overview

Pneumococcal tonsillitis, primarily caused by Streptococcus pneumoniae, is a form of acute tonsillopharyngitis characterized by inflammation of the tonsils often accompanied by symptoms such as sore throat, fever, and difficulty swallowing. 8 18

Diagnosis

Clinical Symptoms: Sore throat, fever, and tonsillar exudates.

Rapid Antigen Detection Tests: Useful for Group A Streptococcus but less specific for pneumococcus.

Throat Culture: Gold standard for identifying Streptococcus pneumoniae.

Serological Markers: Elevated C-reactive protein (CRP) and procalcitonin (PCT) may differentiate bacterial from viral causes 11.

Thiol-Disulphide Homeostasis: Lower native thiol levels in patients with tonsillopharyngitis, though not specific to pneumococcal etiology 3.

Management

Antibiotics: Cefuroxime axetil and other cephalosporins effective for pneumococcal infections 9 17.

Macrolides: Remain effective in regions with low resistance rates 12.

Supportive Care: Symptomatic relief with analgesics (aspirin with caffeine shown to be effective 21).

Pain Management: Perioperative local anesthesia (bupivacaine infiltration) can reduce post-tonsillectomy pain 14.

Topical Treatments: Limited evidence for lysozyme-based sprays in tonsillopharyngitis 1.

Special Populations

Pediatrics: Cefuroxime axetil shown effective in children with recurrent tonsillopharyngitis 20.

Comorbidities: No specific guidelines provided in abstracts; management should consider underlying conditions and antibiotic resistance patterns 15.

Key Recommendations

Use Throat Culture for Diagnosis: Confirm pneumococcal tonsillitis with throat culture 8.

Cefuroxime Axetil as First-Line Antibiotic: Effective for treating pneumococcal tonsillopharyngitis in pediatric and adult populations 9 17.

Consider Macrolides in Low-Resistance Areas: For patients with penicillin allergies or in regions with low macrolide resistance 12.

Implement Perioperative Local Anesthesia: To reduce post-tonsillectomy pain in adults 14.

Utilize Symptomatic Relief with Caffeine-Enhanced Analgesics: Effective for pain management in acute tonsillopharyngitis 21.

(Evidence: Moderate)

References

1 Golac-Guzina N, Novaković Z, Sarajlić Z, Šukalo A, Džananović J, Glamočlija U et al.. Comparative Study of the Efficacy of the Lysozyme, Benzydamine and Chlorhexidine Oral Spray in the Treatment of Acute Tonsillopharyngitis - Results of a Pilot Study. Acta medica academica 2019. link 2 Lau AS, Mamais C, McChesney E, Upile NS, Vaughan C, Veitch J et al.. The BeSMART (Best Supportive Management for Adults Referred with Tonsillopharyngitis) multicentre observational study. Annals of the Royal College of Surgeons of England 2017. link 3 Kara SS, Erel O, Demirdag TB, Cura Yayla BC, Gulhan B, Neselioglu S et al.. Alteration of thiol-disulphide homeostasis in acute tonsillopharyngitis. Redox report : communications in free radical research 2017. link 4 Newton L, Sulman C. A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients. ORL-head and neck nursing : official journal of the Society of Otorhinolaryngology and Head-Neck Nurses 2016. link 5 Liu YM, Zhao JZ, Li BB, Yang JY, Dong XG, Zhang JJ et al.. A report on the first outbreak of a single clone group A Streptococcus (emm-type 89) tonsillopharyngitis in China. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 2014. link 6 Tepe Karaca C, Celebi S, Oysu C, Celik O. Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing?. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2013. link 7 Baradaranfar MH, Zand V, Dadgarnia MH, Atighechi S. Efficacy of clindamycin in reducing pain following tonsillectomy in adults: a double-blind, randomised trial. The Journal of laryngology and otology 2013. link 8 Ozkaya-Parlakay A, Uysal M, Kara A. Group A streptococcal tonsillopharyngitis burden in a tertiary Turkish hospital. The Turkish journal of pediatrics 2012. link 9 Jerath N, Shetty G. Redefining the management of pediatric tonsillopharyngitis with cefprozil. Indian journal of pediatrics 2007. link 10 Grivea IN, Al-Lahham A, Katopodis GD, Syrogiannopoulos GA, Reinert RR. Resistance to erythromycin and telithromycin in Streptococcus pyogenes isolates obtained between 1999 and 2002 from Greek children with tonsillopharyngitis: phenotypic and genotypic analysis. Antimicrobial agents and chemotherapy 2006. link 11 Elsammak M, Hanna H, Ghazal A, Edeen FB, Kandil M. Diagnostic value of serum procalcitonin and C-reactive protein in Egyptian children with streptococcal tonsillopharyngitis. The Pediatric infectious disease journal 2006. link 12 Sakran W, Raz R, Chazan B, Koren A, Colodner R. Susceptibility of Streptococcus pyogenes to two macrolides in northern Israel. International journal of antimicrobial agents 2004. link 13 Bereznoy VV, Riley DS, Wassmer G, Heger M. Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsillopharyngitis: a randomized, double-blind, placebo-controlled trial. Alternative therapies in health and medicine 2003. link 14 Kountakis SE. Effectiveness of perioperative bupivacaine infiltration in tonsillectomy patients. American journal of otolaryngology 2002. link 15 Ciftçi E, Dogru U, Güriz H, Aysev D, Ince E. Investigation of risk factors for tonsillopharyngitis with macrolide resistant Streptococcus pyogenes in Turkish children. Pediatrics international : official journal of the Japan Pediatric Society 2002. link 16 Abdul-Baqi KJ, Shakhatreh FM. Effectiveness of treatment of tonsillopharyngitis: comparative study. The Journal of laryngology and otology 2002. link 17 Adam D, Scholz H, Helmerking M. Comparison of short-course (5 day) cefuroxime axetil with a standard 10 day oral penicillin V regimen in the treatment of tonsillopharyngitis. The Journal of antimicrobial chemotherapy 2000. link 18 Pichichero ME. Group A beta-hemolytic streptococcal infections. Pediatrics in review 1998. link 19 Liu CM, Su CY. Post-operative pain control with topical steroid injection after hot dissection tonsillectomy. The Journal of laryngology and otology 1996. link 20 Holm S, Henning C, Grahn E, Lomberg H, Staley H. Is penicillin the appropriate treatment for recurrent tonsillopharyngitis? Results from a comparative randomized blind study of cefuroxime axetil and phenoxymethylpenicillin in children. The Swedish Study Group. Scandinavian journal of infectious diseases 1995. link 21 Schachtel BP, Fillingim JM, Lane AC, Thoden WR, Baybutt RI. Caffeine as an analgesic adjuvant. A double-blind study comparing aspirin with caffeine to aspirin and placebo in patients with sore throat. Archives of internal medicine 1991. link 22 Murty GE, Watson MG. Diathermy haemostasis at tonsillectomy: current practice--a survey of U.K. otolaryngologists. The Journal of laryngology and otology 1990. link 23 Margileth AM, Thompson HC, Osborne CE. Management criteria, recording of performance, and peer review of tonsillopharyngitis. American journal of diseases of children (1960) 1977. link

Pneumococcal tonsillitis