Tonsillitis

This is an infection of the tonsils. Tonsillitis is most commonly due to a viral infection, and there are a number of viruses which can be involved including Epstein Barr Virus which causes Glandular Fever. The most common bacteria that cause tonsillitis are the Streptococcus bacteria.

The symptoms of tonsillitis are throat pain, fever, difficulty swallowing, pain on swallowing, and/or earache. There is usually bad breath, the voice may change, and there may be difficulty breathing. Children may become irritable and have poor sleep. When looking in the mouth the tonsils are enlarged and red, and pus (white or yellow spots or coating) are seen on the surface of the tonsils. The glands in the upper neck just behind the jaw are also usually enlarged.

It’s impossible to determine whether an episode of tonsillitis is due to a virus or bacteria just by looking at the throat. It is reasonable to initially treat a bout of tonsillitis with Paracetamol, drinking plenty of fluids, and resting. However, most bouts of tonsillitis are treated with antibiotics (which is effective for bacterial infections only). A throat swab may be taken to confirm that bacteria are the cause and if so, which bacterium is responsible for the infection. The most appropriate antibiotic is usually penicillin.

The decision to surgically remove the tonsils (Tonsillectomy) depends on a number of factors. These include the number of infections, their severity, the impact that episodes have on the child, the responsiveness of infections to antibiotics, and whether antibiotics are causing any adverse effects.

In the past, an alternative treatment was the use of low-dose antibiotics over the course of 6 weeks or so. However this has fallen out of favour because of lack of success with infections recurring when the antibiotics are ceased, as well as concerns regarding breeding resistant bacteria. Antibiotics also have adverse effects which can be significant even at low doses.