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Strep Tonsillitis – Dr. Ari Goldsmith

September 14, 2019


Hi everyone, my name is Ari Goldsmith. I’m a pediatric Otolaryngologist at ENT and Allergy Associates. My office is in Bay Ridge Brooklyn and I’m going to talk to you today about tonsillitis. Why is strep important? Strep tonsillitis well… Group A strep obviously Causes children to need a lot of antibiotics. It causes them to miss school It could be contagious to other children and most importantly it has complications. The most famous and most serious that of rheumatic fever. Which consists of problems with the heart types of arthritis certain jerking movements lesions of the skin and rheumatic fever can have very serious consequences. And if untreated Group A strep or strep pyogenes can lead to rheumatic fever. There’s also newer entity. That’s thought to be due to strep pharyngitis or strep tonsillitis called pandas. Which is a behavioral change in the child due to strep antibodies also so if you put all this together the excessive antibiotics that they’re taking the missing school and the potential for serious complications Such as rheumatic fever and also potentially kidney problems You can understand why strep tonsillitis is a very important illness to treat and prevent. The way you diagnose and treat strep tonsillitis is one of two ways. The first way that’s commonly used is a clinical diagnostic method where if the child has symptoms of a sore throat fevers swellings and the lymph glands feeling very sick not eating well and The throat looks red and the throat has maybe some white areas on it. The doctor may make a diagnosis of strep tonsillitis and treated accordingly. The gold standard or the best way to make a diagnosis for strep tonsillitis is via laboratory methods and the way that’s done is initially in the doctor’s office a rapid strep test is taken where the throat is swab and immediately within a minute or two you can have either a positive or negative if the rapid strep test is positive you have strep; if the rapid strep test is negative then you’re not sure and the doctor will then take an overnight regular strep culture to confirm the diagnosis of Strep or not. And based on the diagnosis You can distinguish between strep tonsillitis which needs antibiotics and the other type of tonsillitis I mentioned viral tonsillitis, which doesn’t need antibiotics. Strep is typically treated with a penicillin or related drug Amoxicillin is a drug of choice because as opposed to penicillin It tastes good and it can also be given twice a day or even once a day and as opposed to penicillin which is 3 or 4 times a day, but based on many studies that have looked at the rates of the cure rates for penicillin related drugs The cure rate is virtually 100% despite that there are some doctors that recommend using somewhat stronger antibiotics Because there may be a slight failure rate with amoxicillin those would include augmentin, amoxicillin clavulanate, omnicef cefadroxil cefalexin, cephalexin etc, but in general the standard treatment for Strep tonsillitis is amoxicillin. If child is allergic to penicillin. They can be treated with a macrolide type drug such as biaxin, clarithromycin or zithromax, azithromycin or if it’s a very mild allergy they can be treated with a cephalosporin Such as I mentioned before omnicef. cefadroxil, cefalexin. After about 48 hours of treatment the child is no longer contagious and can go back to school. Tonsillectomy is obviously the removal of the tonsils It’s a very old procedure It’s been done for many many, many, many years. I don’t have the exact amount, but probably over a thousand and The procedure is very safe. It has very few side effects and It works in preventing further episodes of tonsillitis. So when is tonsillectomy recommended for strep tonsillitis? In general, It’s a somewhat subjective issue Again, if the child is getting too many episodes of strep tonsillitis And it’s not getting better with traditional antibiotic therapy or stopping then Tonsillectomy would be indicated. The official numbers that they use are 7 episodes a year for one year five year for two years three a year for three years, but again as I mentioned before it is somewhat subjective if they’re only getting Four episodes a year, but two of them required hospitalization Then that will be serious enough to recommend tonsillectomy. Again, it’s a great procedure. It works. It stops tonsillitis and it’s actually the most common major operation in America on children about 400,000 performed a year. So basically, to conclude strep tonsillitis does have potentially serious complications as I mentioned before Rheumatic fever being the most serious. It’s very responsive to penicillin related drugs amoxicillin being the drug of choice and Tonsillectomy if indicated is a wonderful procedure that works Makes a child healthier and in general allows them to not miss as much school and obviously take much less Antibiotics. If you would like to make an appointment You can call us here at the number that you’re gonna be seeing and we’ll be happy to help you!

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