Tonsillitis and Peritonsillar Abscess Medication

  • Author: Udayan K Shah, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Aug 19, 2011
 

Medication Summary

Medications used to manage tonsillitis include antibiotics, anti-inflammatory agents (eg, corticosteroids), antipyretics and analgesics (eg, acetaminophen, ibuprofen), and immunologic agents (eg, gammaglobulin).

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Corticosteroids

Class Summary

The following agents reduce inflammation, which may impair swallowing and breathing.

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Dexamethasone (Decadron, AK-Dex)

 

Short-acting, rapid-onset glucocorticoid.

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Antibiotics

Class Summary

Therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

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Penicillin (Benzathine, Permapen)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, which results in bactericidal activity.

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Clarithromycin (Biaxin)

 

Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes causing RNA-dependent protein synthesis to arrest. Semisynthetic macrolide with bid dosing.

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Clindamycin (Cleocin)

 

Oral or parenteral antibiotic for anaerobic or susceptible streptococcal, pneumococcal, or staphylococcal species. Considered to have good absorption into bloodstream in both oral and parental forms.

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Vancomycin (Vancocin, Lyphocin)

 

Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins, or who have infections with resistant staphylococci. To avoid toxicity, current recommendation is to assay vancomycin trough levels after third dose drawn 0.5 h prior to next dosing. Use creatinine clearance (CrCl) to adjust dose in patients diagnosed with renal impairment. Used in conjunction with gentamicin for prophylaxis in penicillin allergic patients undergoing gastrointestinal or genitourinary procedures.

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Rifampin (Rifadin, Rimactane)

 

Inhibitor of bacterial DNA-dependent RNA polymerase activity.

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Amoxicillin (Trimox, Amoxil, Biomox)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.

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Amoxicillin-clavulanate (Augmentin)

 

Oral antibiotic with specific activity against penicillin-resistant organisms, due to beta-lactamase inhibitor, clavulanate potassium.

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Metronidazole (Flagyl)

 

Effective in patients with tonsillitis and MN, shortening fever duration and reducing tonsillar size, and in management of acute episodes of nonstreptococcal tonsillitis.

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Immune globulins

Class Summary

These agents are used to improve clinical aspects of the disease.

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Immune globulin intravenous (Gamimune N, Gammagard, Sandoglobulin)

 

Pooled human Ig. Because of shortage of supply, reserved for use for severe infections. Use in accordance with institutional policies. Use in past was more common for various indications.

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Contributor Information and Disclosures
Author

Udayan K Shah, MD  Associate Professor of Otolaryngology-Head and Neck Surgery and Pediatrics, Jefferson Medical College, Thomas Jefferson University; Director, Fellow and Resident Education in Pediatric Otolaryngology, Attending Surgeon, Division of Otolaryngology, Nemours-AI duPont Hospital for Children

Udayan K Shah, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Society of Pediatric Otolaryngology, International Society for Optical Engineering, Pennsylvania Medical Society, Phi Beta Kappa, and Society for Ear, Nose and Throat Advances in Children

Disclosure: Gyrus-ACMI Royalty Device development; Reiseman, Rosenberg LLC Consulting fee medico-legal case review

Specialty Editor Board

Ari J Goldsmith, MD  Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center

Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Gregory C Allen, MD  Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

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Acute bacterial tonsillitis is shown. The tonsils are enlarged and inflamed with exudates. The uvula is midline.
Tonsillitis caused by Epstein-Barr infection (infectious mononucleosis). The enlarged inflamed tonsils are covered with gray-white patches.
Examination of the tonsils and pharynx.
Oral mucosal examination.
 
 
 
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