TREATMENT OF ACUTE VIRAL TONSILLITES
A.S. Polyakova (1, 2), M.D. Bakradze (1, 2), V.K. Tatochenko (1)
1) National Medical Research Center for Children’s Health, Moscow, Russia;
2) Pirogov Russian National Medical Research University, Moscow, Russia
Background. Sore throat is one of the most common complaints in pediatric practice. Most often, it is a consequence of inflammation of the mucous membrane of the posterior pharyngeal wall and palatine tonsils in acute tonsillitis (AT) of both bacterial and viral etiology. Objective. Evaluation of the spectrum of diseases accompanied by changes in the pharyngoscopic pattern, the detection of the incidence of ATs in children, their etiology, and the most effective methods of treatment. Methods. The study included 100 children with pharyngoscopic changes: 83 children with known etiology of tonsillitis (3 children with bacterial tonsillitis and 80 children with viral forms of the disease) and 17 with reliably not clear etiology of tonsillitis. All children underwent general clinical examination with pharyngo-, oto- and anterior rhinoscopy, routine blood and urine tests. Some patients additionally underwent detection of serum C-reactive protein and procalcitonin levels, examination of nasopharyngeal swabs for the detection of respiratory viruses and enteroviruses, examination of serum for the presence of IgM antibodies to the nuclear antigen of the Epstein-Barr virus, as well as a swab from the posterior pharyngeal wall and palatine tonsils to determine β-hemolytic streptococcus group A. Treatment methods. Patients with proven streptococcal tonsillitis received both systemic antibacterial therapy and topical treatment for relief of sore throat. With viral forms of tonsillitis, we tried to prescribe only symptomatic treatment, usually used in ARVI, as well as topical therapy for the relief of inflammation and sore throat. As a drug for topical treatment of tonsillitis, benzodamine hydrochloride was used under the trade name Tantum® Verde in dosage forms of spray and orodispersible tablets with an evaluation of efficacy based on subjective sensations of the patient on a visual analogue scale (VAS) equivalent to 100 points, before and after administration of the drug and objective changes in the pharyngoscopic pattern. Results. More than 95% of patients noted a significant reduction in the pain syndrome in the first 60 seconds after the start of use of Tantum® Verde. Regardless of the etiology of ATs, the VAS score first hour after showed that 83.7% of patients had significant pain relief when using both a spray and tablets. At the end of the first day of topical therapy, there was a clear positive dynamics of subjective sensations and improvement of the pharyngoscopic picture in 75% of cases. At the end of the second day, the other 23% of patients stopped complaining of pain. Conclusion. The vast majority of ATs has a viral etiology. Antibacterial etiotropic therapy of streptococcal tonsillitis quickly relieves fever and improves the patient’s condition. With viral infections, it is only possible to improve the patient’s condition with the use of symptomatic drugs, locally stopping the pain syndrome, mainly in tonsillitis. Preparations containing benzydamine, used for a long time and well-proven, not only meet all the basic requirements for the drugs for topical treatment of ATs, but are also possible for use in different dosage forms.
Keywords: acute tonsillitis, sore throat, streptococcus, antibiotics, symptomatic therapy
About the Autors
Corresponding author: A.S. Polyakova – MD, Pediatrician, Department of Diagnostics and Medical Rehabilitation, National Medical Research Center for Children’s Health; Associate Professor at the Department of Faculty Pediatrics, FP Pirogov RNRMU, Moscow, Russia; tel. +7 (495) 967-14-21, e-mail: email@example.com, ORCID: https://orcid.org/0000-0003-4655-3375