Chronic tonsillitis: medications

The following are the drugs of choice for the cellular (local) and systemic immune status.

IRS 19 - dosed aerosol for intranasal use, contains a lysate of inactivated bacteria of many species; has immunomodulating properties, stimulating the production of secretory immunoglobulins of class A and phagocytosis, increases the lysozyme content of the glands of the mucous membrane of the upper respiratory tract. It is indicated for the prophylaxis and treatment of infectious and inflammatory diseases of ENT organs and respiratory organs: rhinitis, pharyngitis, acute and chronic tonsillitis, laryngitis, as well as for prevention of acute respiratory disease, influenza, etc. It is also used in preparation for surgical intervention on the ENT organs as a preventive tool for preventing postoperative complications of inflammatory nature and optimizing the course of the postoperative period. Application: adults and children from 3 months of age for prevention prescribed 1 dose in each half of the nose 2 times a day for 2 weeks; with tonsillitis and exacerbations of chronic tonsillitis - 1 dose in each half of the nose 2-5 times a day until the symptoms of infection disappear. During the instillation of the drug, do not toss your head back!

Bronchomunal (Bronchomunal P for Children) - 1 capsule contains freeze-dried lysate of many bacteria, most commonly causing respiratory tract infections; has immunomodulating property. It stimulates macrophages, increases the number of circulating T-lymphocytes and antibodies IgA, IgG, and IgM on the mucous membrane of the body, including on the surface of palatine tonsils and upper respiratory tract as a whole. The drug stimulates the natural mechanisms of protecting the body from infectious diseases of the respiratory tract, reduces their frequency and severity, increases the humoral and cellular immunity. Application: per os in the morning on an empty stomach in an acute period of 1 capsule for 10 days. Children are prescribed Bronchomunal P. If the child can not swallow the capsule, then open it and dissolve the contents in a small amount of liquid (tea, milk, juice). If necessary, Bronchomunal can be used with antibiotics.

Imudon - resorption tablets containing a mixture of lysates of many bacteria that cause acute and chronic inflammatory diseases of the pharyngeal mucosa, its lymphadenoid tissue and the airways in general. Stimulates the production of antibodies and phagocytic activity of macrophages. Contraindicated in children under 6 years. Indications: Infectious and inflammatory diseases of the oral cavity and pharynx (pharyngitis, chronic tonsillitis, periodontitis, gingivitis, stomatitis, etc., as well as the prevention and treatment of infectious complications before and after tonsillectomy, removal and implantation of teeth, etc. Usage: the tablet is kept in the mouth , without chewing, until complete resorption.In acute and exacerbation of chronic tonsillitis and other diseases mentioned above, adults and adolescents over 14 years old - 8 tablets per day, children from 6 to 14 years - 6 tablets per day. (including exacerbations of chronic tonsillitis) for adults and children over 6 years of age) are prescribed 6 tablets per day for 20 days or more. For preoperative preparation for 1 week before the intervention of 8 tablets per day, after surgery, 8-10 tablets per day for 1 week. In chronic relapsing tonsillitis in compensated and subcompensated stages, it is recommended to carry out 2-3 courses per year.

Antibacterial therapy is the main element of complex treatment for chronic tonsillitis, but still BS Preobrazhensky (1963), one of the founders of the national school for the study of chronic tonsillitis, pointed out that "The overall treatment of chronic tonsillitis with sulfonamide preparations, antibiotics does not have a significant effect, but these funds are successfully used in the treatment of exacerbations, i.e. With angina. " Currently, in connection with the emergence of new generations of antibiotics, this provision is being revised, but taking into account the concept of polyethiologism of chronic tonsillitis and the multifactority of its pathogenesis.

Modern sulfonamide and antibiotic drugs with exacerbations of chronic tonsillitis and vulgar primary angina and their complications are crucial in the treatment of these diseases. Sulfanilamides have mainly bacteriostatic effect, the period of which, with the continued action of the bacteriostatic drug, ends with lysis, that is, the death of the microorganism. Antibiotics have bacteriostatic and bactericidal properties.

Preparations of the sulfanilamide series are synthetic chemotherapeutic agents, derivatives of sulfanilic acid. They have a wide spectrum of antimicrobial action. The mechanism of their pharmacological action is that they block the acceptance of PABA-obligate "material" by microorganisms for their growth and reproduction and stop the synthesis of folates (folic acid derivatives-dihydrofolic acid and tetrahydrofolic acid, which is necessary for the formation of nucleic acids) due to the fact that sulfonamides having structural similarity with PABA and being its competitive antagonists are captured by a microbial cell and disrupt the formation of nucleic acids necessary for the reproduction of microorganisms. Preparations for the selection of the sulfonamide series used to treat many purulent-inflammatory diseases of the ENT organs are presented below.

Sudfadimethoxin. It has antibacterial action (bacteriostatic), relatively slowly absorbed from the digestive tract. It is indicated for angina, sinusitis, otitis, meningitis, inflammatory diseases of the upper respiratory tract, etc. Usage: per os once a day: on the 1st day 1-2 g, in the following days, 0.5-1 g / day.

Children - 0.25 mg / (kg-day) on day 1 and 12.5 mg / (kg-day) - in the following days.

Sulfadimidine. It has an antimicrobial, antibacterial property (bacteriostatic), it penetrates well into tissues, including into the lungs and into the cerebrospinal fluid. It is indicated for pneumococcal, meningococcal, streptococcal infections, diseases caused by E. Coli: tonsillitis, sinusitis, otitis media, meningitis, inflammatory processes in the airways, etc. Usage: per os, adults 1 g 4-6 times a day; children - at a rate of 0.1 g / kg per 1 reception, then 0.25 g / kg every 4, 6, 8 hours.

Sulfamonomethoxin. Has the same property as the previous two drugs. After ingestion, per os is rapidly absorbed from the digestive tract and distributed evenly throughout the tissues. It is indicated in cases of sore throats, erysipelas and other infections. Application: per os, adults 0.5-1 g 5-6 times a day; children under 1 year - 0.05-0.1 g per reception, 2-5 years - 0.2-0.3 g, 6-12 years - 0.3-0.5 grams. In a mixture with nonsulfazole, penicillin and ephedrine are sometimes used topically in acute purulent rhinitis.

Sulfanilamide. Has antimicrobial and antiprotozoal properties. Quickly and completely absorbed in the digestive tract. It is indicated for sore throats, erysipelas, wound infection, etc. Usage: per os for adults 0.5-1 g 5-6 times a day; children under 1 year - 0.05-1 g per reception, 2-5 years - but 0.2-0.3 g, 6-12 years - 0.3-0.5 grams.

Antibiotics refer to chemotherapeutic substances formed by microorganisms and obtained from plant and animal tissues, as well as to their derivatives and synthetic analogues, selectively inhibiting the causative agents of infectious diseases or the development of malignant tumors; Many antibiotics also have the ability of indirect, indirect action on the body's defense mechanisms (immunomodulating effect) both in the direction of their amplification (immunostimulation) and in the direction of depression (immunosuppression). The massive use of antibiotics for decades on a global scale has led to a significant reduction in the incidence and mortality of many infectious diseases. The main problem that prevents the success of antibiotic treatment is the ability of microorganisms to develop resistance to them. The wide spread of resistant forms of microorganisms, primarily to penicillin, streptomycin, tetracycline, necessitates the introduction of new effective drugs into practice, as well as the rational use of pathogens existing on the basis of preliminary identification and their sensitivity to antibiotics (antibioticogram).

For the treatment of chronic tonsillitis and its complications, the following antibiotics are recommended.

Beta-lactam antibiotics, combining penicillins and cephalosporins, which have a bactericidal property and high activity against primarily gram-positive bacteria. These antibiotics are able to penetrate into the cells of the body and act on the pathogens inside them. Characterized by low toxicity and good tolerability, even with long-term use in high doses, while the resistance of microorganisms during treatment develops slowly.

Preparations of the penicillin series.

Amoxicillin is a semisynthetic antibiotic of the group of penicillins of the third generation, which possesses a bactericidal property due to the inhibitory effect on transpeptidase and the disruption of the synthesis of peptidoglycan (the supporting protein of the cell wall of the microorganism in the period of division and growth), causes lysis of the microorganisms. Penetrates into most tissues, except for the unchanged GEB. Indications: respiratory tract infections and ENT organs (bronchitis, pneumonia, tonsillitis, acute otitis media, pharyngitis, sinusitis) and other organs and systems. Application: per os, adults and adolescents over 10 years - 500-700 mg 2 times a day; children from 3 to 10 years - 375 mg 2 times or 350 mg 3 times a day.

Amoxiclav. 1 tablet, film-coated, contains amoxicillin 250 or 500 mg and potassium salt of clavulanic acid 125 mg. Powder for the preparation of 100 ml of suspension for reception per os in bottles of dark glass, contains 125 and 31.25 mg or 250 and 62.5 mg (for the preparation of a suspension of forte) of active substances, respectively. Lyophilized powder in flasks of 500 or 1000 mg of amoxicillin and 100 and 200 mg of potassium salt of clavulanic acid, respectively, for the preparation of an injection solution. Has the action of amoxicillin + inhibits beta-lactamase (clavulanic acid), which forms a stable inactivated complex with these enzymes and protects amoxicillin from the loss of antibacterial activity caused by the production of beta-lactamases by major pathogens and opportunistic microorganisms. It is active against many gram-positive and gram-negative aerobes and a number of anaerobes. Indications: tonsillitis, pharyngitis, sinusitis, acute and chronic otitis media and other inflammatory diseases of the respiratory tract, urogenital organs, etc. Usage: per os for adults and children with a body weight of more than 40 kg - but 375 or 625 mg (depending on the severity of the infection ) every 8 hours. Suspension and injection solution are prescribed to children and adults in doses according to age, according to the instructions enclosed in the drug package.

Ampicillin. Semisynthetic antibiotic group of penicillins of the third generation, which has bactericidal action. It is active against a wide range of gram-positive and gram-negative microorganisms. Destroyed penicillinase, acid-fast, it is possible to use per os. In the gastrointestinal tract, 30-40% of the dose is absorbed. Indications: angina, exacerbation of chronic tonsillitis, pharyngitis, otitis, sinusitis, meningitis, respiratory infections, etc. Usage: per os regardless of food intake, single dose for adults - 0.5 g, daily - 2-3 grams. Medium-severe infections are injected intramuscularly by adults to 0.25-0.5 g every 6-8 hours. In severe infections, 1-2 grams per os every 4 to 6 hours or intravenously but 0.5 g every 6 hours. Children up to 1 month is not prescribed, in older age is used at the rate of a daily dose of 100-200 mg / kg body weight. The daily dose is divided into A-6 receptions per os. The duration of treatment depends on the severity of the condition and the effectiveness of therapy (from 5-10 days to 2-3 weeks or more).

Taromentine. Produced in tablets and powder for injection. 1 tablet contains amoxicillin 250 or 500 mg and clavulanic acid 125 mg (see above amoxiclav). The drug should not be administered intramuscularly. Indications: tonsillitis, pharyngitis, sinusitis, laryngitis, otitis, etc. It is used for antibiotic prophylaxis in surgery: in the operation up to 1 h - intravenously once 1.2 g during anesthesia, with longer interventions - up to 4 doses during the first 24 hours and several days after the operation.

Cephalosporins.

Ceftriaxone. Has a bacteriostatic property (inhibits transpentidase, disrupts the biosynthesis of the mucopeptide of the bacterial cell wall). It has a wide spectrum of action, it can act on multidrug resistant strains tolerant to penicillins and cephalosporins of the first generations and aminoglycosides (streptomycin, kanamycin, gentamicin, etc.). Indication: upper and lower respiratory tract infections, ENT organs, etc. Application: intramuscularly and intravenously. Adults and children over 12 years 1-2 g once a day, if necessary up to 4 g in two injections after 12 hours. The method of preparation of the solution is indicated in the instructions for the drug.

From cefalosporin series for the treatment of angina and exacerbations of chronic tonsillitis, as well as treatment of chronic tonsillitis without exacerbation, in the presence of contraindications to radical surgical treatment, ceftriaabol, ceftriaxone, ceftizoxime, cephalothym, etc., as well as antimicrobial drugs in combinations can be recommended.

Fugentin. Produced in the form of drops for the nose and ear. Contains gentamicin (active against most Gram-positive and Gram-negative bacteria, including resistant strains) and fusidine (potentiates the effect of gentamicin on staphylococci, including those resistant to other antibiotics, bacteriostatically affects corynebacteria, peptostaphylococci, peptostreptococcus, propionobacteria, clostridia, etc. Indication: purulent-inflammatory diseases of the ear, throat (chronic tonsillitis), nose and paranasal sinuses); It is used as a preventive measure of infectious complications in surgical interventions on the paranasal sinuses. Application: drops in the ear and nose; with chronic tonsillitis 2-3 ml is dissolved in 100-200 ml of distilled water or isotonic sodium chloride solution and washed lacunas, daily 5 days.

Gentamicin. A complex of antibiotics produced by Micromonospora purpurea (Gramicidin). Has a wide spectrum of action against Gram-positive and gram-negative bacteria (including Pseudomonas aeruginosa and E. Coli, Proteus, Staphylococcus, etc.). Indications: ENT diseases caused by microorganisms sensitive to the given drug, etc. Application: intramuscularly, intravenously and topically as drops and rinses of the throat.

Often, with XT and other ENT diseases that do not require intensive suppression of the pathogenic microbiota, homeopathic remedies can be used that have a beneficial effect on trophic processes in the relevant organs, as well as a certain calming and tranquilizing effect.

Lymphomyosot - a drop for taking per os, containing 17 ingredients. Indications: chronic hypertrophic inflammatory processes, including signs of body allergization (enlargement of lymph nodes, exudative diathesis, adenoids, chronic hypertrophic tonsillitis, etc.). Application: per os 10 drops 3 times a day.

Euphorbium compositum Nazentropfen C - a spray for the nose, contains 8 homeopathic remedies, in complex having anti-inflammatory, reparative, antiallergic effect. When inflammatory manifestations are simultaneously used Traumeel C Engiapol. Along with the anti-inflammatory effect, it has a beneficial trophic effect on the mucous membrane. Indication: rhinitis of various genesis (viral, bacterial, allergic, hyperplastic, atrophic), oes, hay fever, adenoids, chronic tonsillitis, ear and auditory tube diseases. Application: intranasally injected into each half of the nose at 1-2 doses 3-5 times a day; children under 6 years - 1 dose 3-4 times a day. It is possible to use children up to 1 year (1 dose 2 times a day).

Concluding the section on the non-surgical treatment of chronic tonsillitis, it should be noted that the effect of such treatment does not occur immediately, but grows gradually and requires several courses of treatment in combination with the appointment of vitamins, restorative physiotherapy measures, observance of rational mode of work and rest, exclusion of domestic and occupational hazards. Non-operative treatment is advisable to spend in sanatorium-resort conditions. The success of nonoperative treatment is largely facilitated by previously conducted "semi-surgical" methods aimed at optimizing the state of the amygdala tissue and its purification from products of chronic inflammation and microorganisms.

[1], [2], [3]