Treatment of sore throat and acute pharyngitis in children

Treatment of tonsillitis and acute pharyngitis varies depending on the etiology of acute tonsillitis and acute pharyngitis. Antibiotics are indicated for streptococcal tonsillopharyngitis, they are not indicated for viral tonsillopharyngitis, and antibiotics are indicated for mycoplasma and chlamydial tonsillitis only in cases where the process is not limited to tonsillitis or pharyngitis, but descends into the bronchi and lungs.

Indications for consultation with other specialists

In mild and uncomplicated forms of acute tonsillitis and acute pharyngitis, there is no need to consult other specialists, but in severe and complicated forms, consultations with an otolaryngologist are indicated.

Indications for hospitalization

• Severity of the child's illness: hyperthermia, severe intoxication, respiratory failure, suspicion of a systemic infectious disease (diphtheria, severe scarlet fever, tularemia, HIV infection, etc.).
• Development of complications of acute tonsillitis and pharyngitis - paratonsillitis or retropharyngeal abscess.

Non-drug treatment of tonsillitis and acute pharyngitis in children

The patient is prescribed bed rest in the acute period of the disease for an average of 5-7 days. The diet is normal. Gargling with 1-2% Lugol's solution is prescribed. 1-2% hexetidine solution (hexoral), etc., warm drinks (milk with Borjomi, milk with soda - 1/2 teaspoon of soda per 1 glass of milk, milk with boiled figs, etc.).

Drug treatment of tonsillitis and acute pharyngitis in children

Acute viral tonsillitis (angina) / tonsillopharyngitis is treated according to the same principles as acute nasopharyngitis (see "Acute nasopharyngitis"). The main directions are anti-inflammatory and antiviral therapy. According to indications, antipyretic and antitussive therapy is carried out. When choosing antipyretic therapy, preference should be given to ibuprofen, which, along with antipyretic, also has an analgesic and anti-inflammatory effect.

Systemic antibacterial therapy for viral tonsillitis/tonsillopharyngitis is not indicated. However, for frequently ill children over 2.5 years of age, it is recommended to prescribe a local herbal antibacterial drug fusafungine (bioparox, which is prescribed in an aerosol, 4 sprays into the mouth for 7 days, a non-steroidal anti-inflammatory drug benzydamine (Tantum Verde) or local antiseptics containing hexetidine (geksoral), ambazon (faringosept) or a mixture of bacterial lysates (imudon). Tantum Verde, a metered spray, is used in 4 doses every 1.5-3 hours, for children under 6 years old - 1 dose for every 4 kg of body weight. Hexetidine is prescribed in an aerosol, 1 spray into the mouth 3-4 times a day. Ambazon and a mixture of lysates are prescribed 1 tablet 3 times a day. Adaptogens are also prescribed, which are herbal preparations, for example, tonsilgon N, which includes marshmallow root, chamomile flowers, horsetail, walnut leaf, oak bark, yarrow, dandelion.

In the complex therapy of acute viral tonsillitis (angina) / tonsillopharyngitis in children, it is recommended to prescribe herbal medicines, such as Tonsilgon N, which includes marshmallow root, chamomile flowers, horsetail grass, walnut leaves, oak bark, yarrow grass, and dandelion grass. Tonsilgon N has complex anti-inflammatory, anti-edematous, local enveloping and analgesic effects. The active components of chamomile, marshmallow and horsetail help to increase the body's non-specific defense factors, which allows prescribing Tonsilgon N to children who are often and long-term ill, starting from infancy. Tonsilgon N is available in the form of drops in a 100 ml bottle for oral administration, as well as in the form of dragees for children from 6 years of age.

Treatment of acute streptococcal tonsillitis (sore throat) / tonsillopharyngitis and pharyngitis, on the contrary, includes mandatory antibacterial therapy with systemic antibiotics to avoid the development of such severe complications as glomerulonephritis and rheumatic fever. Thus, the indication for prescribing systemic antibiotics for acute tonsillitis (sore throat) and tonsillopharyngitis is streptococcal etiology, which is evidenced by purulent exudation, the appearance of purulent yellowish plaque on the tonsils and the back wall of the pharynx, and the culture of streptococcus from the pharynx.

• The drug of choice is phenoxymethylpenicillin orally at 50-100 mg/kg per day in 3 doses for 10 days.
• For frequently ill children, amoxicillin is recommended orally at 25-50 mg/kg per day in 2 doses or amoxicillin + clavulanic acid orally at 0.625 g 3 times per day or 1 g 2 times per day for 7-10 days.
• In case of penicillin intolerance, one of the following drugs is prescribed: macrolides; cephalexin orally for children under 12 years old 25-50 mg/kg per day in 3-4 doses; for children over 12 years old 1 g in 2-3 doses; cefadroxil orally 30 mg/kg 2 times a day for children under 12 years old, for children over 12 years old 1 g in 2 doses for 7-10 days.
• In case of intolerance to beta-lactams and macrolides, lincosamines (lincomycin) are prescribed. Lincomycin is prescribed orally at 60 mg/kg in 3 doses.

Of the registered amoxicillin preparations, Flemoxin Solutab has the most optimal pharmacokinetic characteristics. The absorption of the drug when taken orally is 93% and significantly exceeds that when using amoxicillin in capsules (=70%).

The drug is available in the form of dispersible tablets Solutab. The innovative technology of Solutab allows the active substance to be enclosed in microspheres, from which the tablet is formed. Each microsphere consists of an acid-resistant filler, which protects its contents from the action of gastric juice. The release of active components begins at an alkaline pH in the upper intestine, i.e. in the zone of maximum absorption.

Flemoxin Solutab tablets can be taken in different ways: taken whole, divided into parts, prepared as a syrup or suspension with a pleasant fruity taste. A variety of dosages (tablets contain 125, 250, 500 and 1000 mg of the active substance) allow Flemoxin Solutab to be used by children of different ages, starting from 1 month. The 1000 mg release form allows you to reduce the intake of amoxicillin to 2 times a day with the same effectiveness and safety as the standard regimen (500 mg 3 times a day).

In case of mycoplasma and chlamydial etiology of tonsillitis and pharyngitis, systemic antibacterial therapy is also indicated, but the drugs of choice are macrolides.

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Surgical treatment of tonsillitis and acute pharyngitis in children

Not indicated, except for complications - paratonsillar abscess and retropharyngeal abscess. In this case, the child is hospitalized in the otolaryngology department, where the abscesses are opened; in case of recurrence of paratonsillar abscesses, tonsillectomy is indicated.

Prognosis of tonsillitis and acute pharyngitis in children

Favorable.