Angina (acute tonsillitis): treatment

Angina treatment has several purposes - eliminating inflammatory changes in the throat and other clinical conditions of the disease, eradication of the pathogen, preventing the development of common to local complications, and preventing the spread of the disease among others.

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Non-medicamentous treatment of angina

In the early days, a strict bed rest is prescribed, followed by a home stay with limited physical activity, which is important for preventing complications. The patient should provide a separate dish, a towel, as much as possible to limit contact with others, especially with children. Recommend a plentiful drink (fruit juices, tea with lemon, rose hips, Borjomi, etc.), sparing, non-irritating, mainly milk-vegetable diet, rich in vitamins.

Medicinal treatment of sore throats

In accordance with international recommendations, as a drug of choice in streptococcal tonsillitis, phenoxymethylpenicillin is prescribed (0.5 g every 6 hours, ingested one hour before meals). The course of treatment of angina is less than 10 days. The reason for choosing this particular drug is the fact that phenoxymethylpenicillin has a high activity against beta-hemolytic streptococcus and a narrow antimicrobial spectrum, due to which its "ecological pressure" to a normal microflora is minimized.

Amoxicillin is widely used, characterized by high bioavailability (up to 93%), not dependent on food intake, and improved tolerability. It should be noted that domestic specialists consider amoxicillin as a first-line drug in the treatment of angina caused by beta-hemolytic streptococcus in group A. Amoxicillin is slowly excreted from the body enough to prescribe 3, and in some cases, 2 times a day. Flemoxin-Sodutab dosage form is widely used. Which after intake is almost completely absorbed. Assign Flemoxin Solutab in tablets to adults 500 mg twice a day before or after taking the write. The drug can be used during pregnancy, because its negative effect on the fetus is minimal.

In severe cases of angina, as well as during the recurrence of the disease, preference is given to inhibitor-protected penicillins (amoxicillin + and clavulanic acid 0.625-1.0 g every 8-12 hours, preferably with meals). After ingestion, the drug is quickly absorbed regardless of the intake of food; the incoming and its composition clavulanic acid inhibits a significant number of beta-lactamases produced by aerobic and anaerobic bacteria.

In the presence of an allergy to penicillins, macrolides and oral cephalosporins of I-II generations are among the alternative antibiotics used to treat angina streptococcal etiology.

Of the macrolide group, azithromycin is used, which does not break down in the stomach. In tonsils quickly creates a high concentration of the drug, which due to a long half-life of the tissues is stored up to 7 days after the end of admission. This allows you to use azithromycin 500 mg once a day for 3-5 days instead of the usual 10. The drug should be taken 1 hour before or 2 hours after eating. They note good tolerability of the drug in children and adults, side effects when it is used are extremely rare. To treat tonsillitis and exacerbation of chronic tonsillitis, other macrolides are also used: spiramycin - 3 million ME 2 times a day; roxithromycin - 150 mg twice a day; midekamycin - 400 mg 3 times a day. These macrolides are used for 10 days.

Antibiotics of the cephaloslorin series are also used to treat angina. These drugs are in third place in the frequency of appointment. Cephalexin, attributed to the first generation of cephalosporins, has a quick and reliable effect on sore throats caused by Gram-positive coccal flora; prescribe inside before meals to 500 mg 2-4 times a day. Cefuroxime can be given initially parenterally 1.5 g 2-3 times a day, and after normalizing the temperature, reducing the pain in the throat and restoring the ability to swallow normally, you can go to the intake (150-500 mg 2 times a day).

Carbapenems have the broadest spectrum of antibacterial activity, therefore these antibiotics play the role of a means of empirical therapy of the most severe complications of inflammatory diseases of the pharynx. Of this group, imipenem is used, which has increased resistance to chromosomal and plasmid beta-lactamases. The drug is administered intravenously drip or intramuscularly in a dose of up to 1.5-2 g per day (500 mg every 6-8-12 hours). Meropenem is characterized by high efficacy in severe infectious complications accompanied by neutropenic reaction, as well as in the development of nosocomial infection in the patient in the postoperative period, for example, after abscessesonzilllectomy.

Neither fluoroquinolones nor tetracyclines are mentioned in modern guidelines for the treatment of angina streptococcal etiology, since they do not have clinically significant activity against group A beta-hemolytic streptococcus.

Sulfanilamides by activity are much inferior to modern antibiotics and at the same time are characterized by high toxicity. Most clinically relevant pathogens are resistant to sulfonamides. Therefore, in the treatment of angina, sulfanilamides are practically not used at present. Do not recommend for the treatment of angina and co-trimoxazole, since in recent years, the resistance of microorganisms to this drug has increased significantly; in addition, its potential toxicity should be considered.

Studies of recent years have shown that a complete 10-day course of antibiotic therapy is needed to completely sanitize tonsils and, consequently, to fully prevent post-streptococcal diseases, which has proved to be effective for an adequately selected drug. The exception is azithromycin, which due to the peculiarities of pharmacodynamics can be used for 5 days.

Simultaneously with antibiotic therapy, the appointment of aitigistamine drugs (chloropyramine, clemastine, henfenadine, loratadip, feksofenadn, etc.), vitamins, especially C and group B.

In some cases, when the beta-streptococcal nature of the disease is not confirmed, the use of antibacterial agents of local action is justified. The advantage of the local action of the drug when it comes directly to the mucous membrane of the tonsils and pharynx, the lack or minimization of its resorptive action, which is especially important, for example, in the treatment of angina in a pregnant woman or a nursing mother. For local effects, the antibiotic fusafungin is widely used (it is available in the form of the aerosol preparation Bioparox for inhalations through the mouth every 4 hours), which has a broad spectrum of antimicrobial action and simultaneously has an anti-inflammatory effect. In catarrhal sinus, treatment with fuzangin inhalation may be sufficient, with severe forms of angina this drug is used as an auxiliary, with the mandatory appointment of systemic antibiotic therapy.

You can also recommend an antiseptic for topical application of stopangin. In addition to antibacterial action, the drug has antifungal activity and shows an analgesic effect. Locally applied strepsils plus in the form of a spray, which includes two antiseptic components (dichlorobenzyl alcohol and amylmetacrezole) and an application anesthetic lidocaine.

It is also prescribed to rinse the pharynx 5-6 times during the day with a warm solution of nitrofural at a dilution of 1: 5000, soda (1 teaspoon per glass of water), decoctions of herbs (sage, chamomile, calendula, etc.), 0.01% myramistin solution, hydrogen peroxide (2 tablespoons 3% solution per glass of water), etc.

To increase the local and general resistance of the body use immunomodulators, including bacterial lysate mixture. The drug contains lysates of the main pathogens of the oral cavity and pharynx. Take 1 tablet, rassasyvaya in the mouth, 5 times a day for a week, then continue 1 tablet 3 times a day for another week).

Phytopreparation tonzigon has anti-inflammatory, immunostimulating effect, increases the phagocytic activity of macrophages and granulocytes increases the rate of destruction of phagocytized microorganisms. The drug is prescribed for adults 25 drops 5 times a day, for infants - 5 drops. After the disappearance of acute manifestations of the disease, the frequency of admission is reduced to 3 times a day; course - up to 4-6 weeks. Among local appointments also a warming compress on the submandibular area, which should be changed every 4 hours.

In the treatment of angina Simanovsky-Plaut-Vincent, care of the oral cavity, sanitation of carious teeth and peri-gingival pockets, often foci of fusospirillosis, is important. Assign a non-irritating and vitamin-rich diet. Every day, a careful cleansing of the ulcer from the necrotic masses is made and treatment with antiseptics. Assign rinsing h 5 pa per day with hydrogen peroxide solution (1-2 tablespoons 3% solution per glass of water), potassium permanganate in the dilution 1: 2000, ethacridine in the dilution 1: 2000. The ulcerous surface is treated with 5% tincture of iodine, 1% alcohol solution of methylene blue, stewed with 10% silver nitrate solution.

With fungal angina, it is necessary to cancel antibiotics, to take measures to increase the overall and local resistance of the body. Intravenous groups B, C and K are recommended. It is recommended to dissolve tablets with dequalinium chloride 1-2 tablets every 3-5 hours in the mouth. Affected areas of the mucosa are lubricated with solutions of natamycin, terbinafine, batrafen, 2% aqueous or alcoholic solutions of aniline dyes-methylene blue and gentian violet, 5% silver nitrate solution. For systemic antifungal therapy fluconazole is used in capsules at 0,05-0,1 g once a day and for 7-14 days, itraconazole in capsules 0.1 g 1-2 paz per day for 3 weeks.

In viral sore throat, antibiotics are not indicated as starting therapy, but can be prescribed in case of bacterial infection. Recommend irrigation of the pharynx with interferon, disinfecting rinses. Antiviral drugs are prescribed usually in herpetic lesions. Apply acyclovir to 0.2 grams in tablets 3-5 times a day for 5 days, tiloron to 0.125 g in tablets 2 times a day for the first 2 days, then to 1 tablet every 48 hours for a week. Symptomatic and general restorative therapy is also shown.

With infectious angina (diphtheria, measles, scarlet fever, etc.), the main disease is treated under the supervision of an infectious disease specialist; angina in a patient With a blood disease treated by a hematologist.

After the elimination of local and general manifestations of the disease, you should wait 2-3 days before you are allowed to start work. In the next 3-4 weeks, it is recommended to maintain a gentle regime: to limit physical activity, to avoid hypothermia.

Depending on the form of tonsillitis and the peculiarities of its clinical course, the nature and duration of treatment of angina are different.

Surgical treatment of sore throat

Surgical treatment of sore throat is performed in the case of diagnosis of phlegmonous sore throat (intrathonylar abscess). Treatment consists in a wide dissection of the abscess. With relapse, which is observed quite often, tonsillectomy is indicated.

Further management

Within 3 weeks after clinical recovery, the patient who has transferred tonsillitis is shown taking complex vitamin preparations (vitamins C, A, D, group B, etc.), in some cases, recommended the use of topical immunomodulators (imudon).

If there was streptococcal angina, then it is necessary to perform an electrocardiogram, to make a clinical analysis of blood, urine. Consultations of a rheumatologist, a therapist are shown, if there are appropriate complaints - a nephrologist. Then, the otorhinolaryngologists are examined to exclude chronic tonsillitis. It should be borne in mind that earlier than 3 weeks with mesopharyngoscopy, it is difficult to differentiate residual angina and local signs of chronic tonsillitis.

It must be remembered that angina is an infectious disease and there is a high probability of spreading the infection among persons with whom the patient communicates, until the 10th to 12th day of the disease, but especially in the early days of the disease. Therefore, it is necessary to limit as much as possible its contacts with others, especially with children, to use individual dishes, to ventilate the room where the patient is most often. Even after a clinical recovery, some people who have had a sore throat remain carriers of the infection and can infect others. Identify the carrier of infection can be by bacteriological examination of the material from the surface of the tonsils and the posterior pharyngeal wall.

Treatment of sore throats, consisting only of local remedies (rinsing, aerosols, antiseptics in dragees or tablets for resorption in the mouth) is in most cases ineffective. It is necessary to conduct antibiotic therapy for the purpose of aracha.