Original ContributionManagement of recurrent tonsillitis in children☆,☆☆,★
Introduction
In the present state of medical literature, tonsils are considered as assets to the immunological system and they are removed or partially excised only when there is a medical necessity caused by their size, recurrent bacterial infections or tumor [1]. Recurrent tonsillitis has been defined as four or more confirmed infection episodes per year with streptococci A-infection diagnosed in one of them [2]. Prevalence is from 11.0 to 12.3% with marked family burden and risk of man serious complication especially in developing countries [3]. Recurrent tonsillitis is usually treated by either tonsillectomy or conservative medical treatment when tonsillectomy criteria are not fulfilled or there is a contraindication for tonsillectomy [4]. A review by Burton et al. in 2014 found that children with recurrent acute tonsillitis have a small benefit from adeno-/tonsillectomy [5]. The procedure will avoid only 0.6 episodes of any type of sore throat in the first year after surgery compared to non-surgical treatment. The children who had surgery had three episodes of sore throat on average compared to 3.6 episodes experienced by the other children. One of the three episodes is the episode of pain caused by surgery. It seems that children with the more severe and frequent tonsillitis are the ones who benefit from surgery in comparison to the less severely affected children [5].
Sirimanna et al. reported the usefulness of long-acting penicillin in significant reduction of recurrent tonsillitis [6]. However, long acting penicillin has multiple drawbacks such as hypersensitivity reactions, anaphylaxis and severe local pain [7].
Azithromycin (AZT) is an Azalide, a subclass of macrolide antibiotic which is widely distributed throughout the body, achieving higher concentrations in tonsillar tissues with adequate therapeutic levels during medication with minimal side effects [8].
Recurrent tonsillitis always present on a continuum rather than a dichotic representation. Children seem to suffer from different grades of recurrent tonsillitis. The possibility of having other treatment measures than tonsillectomy is tempting especially when the child has recurrent tonsillitis that falls little short of the criteria for tonsillectomy [9].
The aim of the present study was to compare the efficacy of AZT and benzathine penicillin (BP)—both administered for six months in the management of recurrent tonsillitis—to conventional tonsillectomy.
Section snippets
Design, setting and participants
A randomized controlled clinical trial study created in the otolaryngology department - Suez Canal University Hospital – Ismailia – Egypt and Alexandria University Children Hospital – Egypt from March 2005 to May 2012. The study protocol was approved by the local faculty ethics committee and written informed consent was obtained from all patients relevant.
Patient eligibility and enrolment
A total of 350 children with recurrent tonsillitis were included in the study. Recurrent tonsillitis was defined as four or more episodes of
ASOT and ESR levels
The tonsillectomy group had a mean ESR level of 70.3 ± 13.1 ml/h during the last episode of tonsillitis before tonsillectomy. Six months after the operation this level dropped to 8.7 ± 1.9 ml/h (P = 0.005). The mean ASOT for the tonsillectomy group was 436 IU/ml before surgery and declined to 115 IU/ml after six months with statistically significant improvement (P = 0.006).
The mean ASOT before treatment in group A was 476 IU/ml and 491 IU/ml in group B. After six-months follow-up a statistically significant
Discussion
Recurrent tonsillitis is considered to be one of the common reasons for primary care visits to physicians. Recurrent tonsillitis among children has a considerable impact on the quality of life, not only due to the effects on children but also the burden on the parents when their child is suffering. Tonsillectomy remains a common procedure, especially in western countries [12]. However, a number of immunological studies on the effects of tonsillectomy point to the importance of a conservative
Conclusion
The treatment of recurrent tonsillitis is equally effective by treatment with AZT or BP in comparison to tonsillectomy. AZT was as effective as BP and tonsillectomy against recurrent tonsillitis after six months of treatment.
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