Chronic tonsillitis - Medicines

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

IRS 19 is a metered-dose aerosol for intranasal use, contains a lysate of inactivated bacteria of many species; has an immunomodulatory property, stimulating the production of secretory immunoglobulins of class A and phagocytosis, increases the content of lysozyme of the glands of the mucous membrane of the upper respiratory tract. Indicated for the prevention and treatment of infectious and inflammatory diseases of the ENT organs and respiratory organs: rhinitis, pharyngitis, acute and chronic tonsillitis, laryngitis, as well as for the prevention of acute respiratory infections, influenza, etc. It is also used in preparation for surgery on the ENT organs as a prophylactic agent to prevent postoperative inflammatory complications and optimize the course of the postoperative period. Application: adults and children from 3 months of age are prescribed 1 dose in each half of the nose 2 times a day for 2 weeks for prophylaxis; for sore throats and exacerbations of chronic tonsillitis - 1 dose in each half of the nose 2-5 times a day until the symptoms of infection disappear. Do not tilt your head back during instillation of the drug!

Bronchomunal (Bronchomunal P for children) - 1 capsule contains lyophilized lysate of many bacteria that most often cause respiratory tract infections; has immunomodulatory properties. Stimulates macrophages, increases the number of circulating T-lymphocytes and IgA, IgG, and IgM antibodies on the mucous membrane of the body, including the surface of the tonsils and the upper respiratory tract as a whole. The drug stimulates the body's natural defense mechanisms against infectious diseases of the respiratory tract, reduces their frequency and severity, increases humoral and cellular immunity. Application: per os in the morning on an empty stomach in the acute period, 1 capsule for 10 days. Children are prescribed Bronchomunal P. If the child cannot swallow the capsule, it is opened and the contents are dissolved in a small amount of liquid (tea, milk, juice). If necessary, Bronchomunal can be used with antibiotics.

Imudon - lozenges containing a mixture of lysates of many bacteria that cause acute and chronic inflammatory diseases of the mucous membrane of the pharynx, its lymphadenoid tissue and the respiratory tract as a whole. Stimulates the production of antibodies and the phagocytic activity of macrophages. Contraindicated for children under 6 years of age. 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, tooth extraction and implantation, etc. Application: keep the tablet in the mouth without chewing until completely dissolved. For acute and exacerbation of chronic tonsillitis and other diseases listed above, adults and adolescents over 14 years old - 8 tablets per day; children from 6 to 14 years old - 6 tablets per day. For the prevention of chronic inflammatory diseases (including exacerbations of chronic tonsillitis), adults and children over 6 years old are prescribed 6 tablets per day for 20 days or more. For preoperative preparation 1 week before the intervention, 8 tablets per day, after the operation 8-10 tablets per day for 1 week. For chronic recurrent tonsillitis in compensated and subcompensated stages, it is recommended to take 2-3 courses per year.

Antibacterial therapy is the main element of complex treatment for chronic tonsillitis, however, B.S. Preobrazhensky (1963), one of the founders of the Russian school of studying chronic tonsillitis, pointed out that "General treatment of chronic tonsillitis with sulfanilamide drugs and antibiotics does not produce a significant effect, but these drugs are successfully used in the treatment of exacerbations, i.e., sore throats." Currently, due to the emergence of new generations of antibiotics, this position is being revised, but taking into account the concept of the polyetiology of chronic tonsillitis and the multifactorial nature of its pathogenesis.

Modern sulfonamide and antibiotic drugs are of decisive importance in the treatment of these diseases in cases of exacerbation of chronic tonsillitis and vulgar primary tonsillitis and their complications. Sulfonamides have mainly a bacteriostatic effect, the period of which, with the continued action of the bacteriostatic drug, ends with lysis, i.e., the death of the microorganism. Antibiotics have bacteriostatic and bactericidal properties.

Sulfanilamide drugs 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 by microorganisms - an obligate "material" 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, which have a structural similarity with PABA and are its competitive antagonists, are captured by the microbial cell and disrupt the formation of nucleic acids necessary for the reproduction of microorganisms. The drugs of choice of the sulfanilamide series, used to treat many purulent-inflammatory diseases of the ENT organs, are presented below.

Sudfadimethoxin. Has an antibacterial effect (bacteriostatic), is absorbed from the gastrointestinal tract relatively slowly. Indicated for tonsillitis, sinusitis, otitis, meningitis, inflammatory diseases of the upper respiratory tract, etc. Application: per os once a day: on the 1st day 1-2 g, on subsequent days 0.5-1 g / day.

For children - 0.25 mg/(kg-day) on the 1st day and 12.5 mg/(kg-day) on subsequent days.

Sulfadimidine. Has antimicrobial, antibacterial properties (bacteriostatic), penetrates well into tissues, including the lungs and cerebrospinal fluid. Indicated for pneumococcal, meningococcal, streptococcal infections, diseases caused by E. coli: tonsillitis, sinusitis, otitis, meningitis, inflammatory processes in the respiratory tract, etc. Application: per os, adults 1 g 4-6 times a day; children - at the rate of 0.1 g / kg per 1 dose, then 0.25 g / kg every 4, 6, 8 hours.

Sulfamonomethoxine. Has the same properties as the previous two drugs. After oral administration, it is quickly absorbed from the gastrointestinal tract and evenly distributed throughout the tissues. It is indicated for 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 dose, 2-5 years - 0.2-0.3 g, 6-12 years - 0.3-0.5 g. In a mixture with norsulfazole, penicillin and ephedrine, it is sometimes used locally for acute purulent rhinitis.

Sulfanilamide. Has antimicrobial and antiprotozoal properties. Quickly and completely absorbed in the gastrointestinal tract. Indicated for tonsillitis, erysipelas, wound infection, etc. Application: per os for adults 0.5-1 g 5-6 times a day; children under 1 year - 0.05-1 g per dose, 2-5 years - 0.2-0.3 g, 6-12 years - 0.3-0.5 g.

Antibiotics are chemotherapeutic substances produced by microorganisms and obtained from plant and animal tissues, as well as their derivatives and synthetic analogues, selectively suppressing pathogens of infectious diseases or the development of malignant tumors; many antibiotics also have the ability to indirectly, mediately act on the body's defense mechanisms (immunomodulatory effect) both in the direction of their enhancement (immunostimulation) and in the direction of suppression (immunosuppression). The widespread use of antibiotics over decades on a global scale has led to a significant decrease in the incidence of many infectious diseases and mortality from them. The main problem that hinders the success of antibiotic treatment is the ability of microorganisms to develop resistance to them. The widespread use of resistant forms of microorganisms, primarily to penicillin, streptomycin, and tetracycline, necessitates the introduction of new effective drugs into practice, as well as the rational use of existing ones based on preliminary identification of pathogens and determination of their sensitivity to antibiotics (antibioticogram).

The following antibiotics are recommended for the treatment of chronic tonsillitis and its complications.

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 the body's cells and affect the pathogens inside them. They are characterized by low toxicity and good tolerability even with prolonged use in large doses, while the resistance of microorganisms develops slowly during treatment.

Penicillin series drugs.

Amoxicillin is a semi-synthetic antibiotic of the third-generation penicillin group, which has a bactericidal property due to the inhibitory effect on transpeptidase and disruption of the synthesis of peptidoglycan (the supporting protein of the cell wall of a microorganism during division and growth), causing lysis of microorganisms. Penetrates most tissues, except for the unchanged BBB. Indications: infections of the respiratory tract 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 old - 500-700 mg 2 times a day; children from 3 to 10 years old - 375 mg 2 times or 350 mg 3 times a day.

Amoxiclav. 1 film-coated tablet contains amoxicillin 250 or 500 mg and potassium salt of clavulanic acid 125 mg. Powder for the preparation of 100 ml of suspension for oral administration in dark glass vials contains 125 and 31.25 mg or 250 and 62.5 mg (for the preparation of forte suspension) of active substances, respectively. Lyophilized powder in vials 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. It has the effect of amoxicillin + inhibits beta-lactamases (clavulanic acid), which forms a stable inactivated complex with the specified enzymes and protects amoxicillin from the loss of antibacterial activity caused by the production of beta-lactamases by the main 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, genitourinary organs, etc. Application: per os for adults and children weighing 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 appropriate for age, according to the instructions included in the package of the drug.

Ampicillin. A semi-synthetic antibiotic of the third-generation penicillin group with bactericidal action. It is active against a wide range of gram-positive and gram-negative microorganisms. It is destroyed by penicillinase, acid-resistant, and can be used per os. 30-40% of the dose is absorbed in the gastrointestinal tract. Indications: tonsillitis, exacerbation of chronic tonsillitis, pharyngitis, otitis, sinusitis, meningitis, infectious diseases of the respiratory tract, etc. Application: per os regardless of food intake, a single dose for adults is 0.5 g, daily - 2-3 g. For moderate infections, 0.25-0.5 g is administered intramuscularly to adults every 6-8 hours. For severe infections - 1-2 g per os every 4-6 hours or intravenously but 0.5 g every 6 hours. It is not prescribed to children under 1 month, at an older age it is used at a daily dose of 100-200 mg / kg of body weight. The daily dose is divided into 1-6 per os doses. 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).

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

Cephalosporins.

Ceftriaxone. Has a bacteriostatic property (inhibits transpentidase, disrupts the biosynthesis of bacterial cell wall mucopeptide). Has a broad spectrum of action, can act on multiresistant strains that are tolerant to penicillins and first-generation cephalosporins and aminoglycosides (streptomycin, kanamycin, gentamicin, etc.). Indications: infections of the upper and lower respiratory tract, ENT organs, etc. Application: intramuscular and intravenous. Adults and children over 12 years old 1-2 g once a day, if necessary, up to 4 g in two injections after 12 hours. The method of preparing the solution is indicated in the instructions for the drug.

Of the cephalosporin drugs for the treatment of tonsillitis and exacerbations of chronic tonsillitis, as well as the treatment of chronic tonsillitis outside of exacerbation in the presence of contraindications to radical surgical treatment, ceftriabol, ceftriaxone, ceftizoxime, cephalotim, etc., as well as antimicrobial drugs in combinations, can be recommended.

Fugentin. Available in the form of nasal and ear drops. Contains gentamicin (active against most gram-positive and gram-negative bacteria, including resistant strains) and fusidin (potentiates the effect of gentamicin on staphylococci, including those resistant to other antibiotics, has a bacteriostatic effect on corynebacteria, peptostaphylococci, peptostreptococci, propionobacteria, clostridia, etc. Indications: purulent-inflammatory diseases of the ear, throat (chronic tonsillitis), nose and paranasal sinuses); used to prevent infectious complications during surgery on the paranasal sinuses. Application: ear and nose drops; For chronic tonsillitis, 2-3 ml is dissolved in 100-200 ml of distilled water or isotonic sodium chloride solution and the lacunae are washed daily for 5 days.

Gentamicin. A complex of antibiotics produced by Micromonospora purpurea (Gramicidin). Has a broad spectrum of action against gram-positive and gram-negative bacteria (including Pseudomonas aeruginosa and E. coli, Proteus, staphylococci, etc.). Indications: ENT diseases caused by microorganisms sensitive to this drug, etc. Application: intramuscularly, intravenously and locally in the form of drops and gargles.

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

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

Euphorbium compositum Nazentropfen S is a nasal spray containing 8 homeopathic remedies that together provide anti-inflammatory, reparative and anti-allergic effects. Traumeel S Engiapol is used simultaneously for inflammatory manifestations. Along with the anti-inflammatory effect, it has a beneficial trophic effect on the mucous membrane. Indications: rhinitis of various origins (viral, bacterial, allergic, hyperplastic, atrophic), ozena, hay fever, adenoids, chronic tonsillitis, diseases of the ear and auditory tube. Application: spray intranasally into each half of the nose, 1-2 doses 3-5 times a day; children under 6 years old - 1 dose 3-4 times a day. Can be used by children under 1 year old (1 dose 2 times a day).

In conclusion of the section on non-surgical treatment of chronic tonsillitis, it should be noted that the effect of such treatment does not occur immediately, but increases gradually and requires several courses of treatment in combination with the prescription of vitamins, general strengthening physiotherapeutic measures, compliance with a rational work and rest regime, and the exclusion of household and professional hazards. Non-surgical treatment is advisable to carry out in sanatorium and resort conditions. The success of non-surgical treatment is largely facilitated by preliminary "semi-surgical" methods aimed at optimizing the condition of the tonsil tissue and cleansing it of chronic inflammation products and microorganisms.

[ 1 ], [ 2 ], [ 3 ]