Purulent (follicular and lacunar) tonsillitis

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15 minutes

Author, editor and medical expert – Klimovich Elina Valerievna.

Editor and medical expert – Harutyunyan Mariam Harutyunovna.

Sore throat, or tonsillitis, is usually called acute inflammation of one or even several tonsils of the pharyngeal lymphoid ring. This pathology is extremely common, so in pharmacies, remedies for the treatment of sore throat are usually in great demand. Read more about the disease, how to recover faster and not get sick again in our article.

The pharyngeal lymphoid ring consists of six large tonsils:

• two palatines, which are located in the recesses on either side of the entrance to the pharynx,
• two tubes located in the area of ​​the auditory tubes in the nasopharynx,
• one lingual - at the root of the tongue,
• one pharyngeal - in the upper part of the pharynx5.

Small lymphoid formations form lateral ridges and single tubercles on the posterior wall of the pharynx5.

The lymphoid ring serves as a barrier to the penetration of microbes into the respiratory and digestive tracts and is involved in the formation of immunity. The tonsils have many depressions (lacunae) and crypts, into which various microorganisms constantly penetrate. They activate immune cells, which trigger the production of immune proteins-antibodies, which provide protection against infections. With a decrease in immunity and a high degree of aggressiveness of infectious agents, the tonsils become inflamed - tonsillitis develops.

In children, adenoiditis1, or infection of the pharyngeal accumulations of lymphoid tissue - adenoids, is more common. In adults seeking treatment, sore throats are often palatal. Therefore, the term “tonsillitis” often refers to inflammation of the palatine tonsils – tonsils2.

The winter-spring period is considered dangerous in terms of the disease3. At this time, tonsillitis usually develops as complications of acute respiratory viral infections. This is facilitated1,2:

• decrease in the body's defenses,
• unfavorable environmental conditions (temperature fluctuations, high or low humidity, lack of vitamins, etc.)1.

In addition, factors such as:

1. trauma to the tonsils (for example, with a fish bone),
2. genetic predisposition,
3. the presence of foci of chronic infection in the mouth, nose and paranasal sinuses1,2.

The culprits of the disease can be a variety of microorganisms. In children, beta-hemolytic streptococcus is in first place among all infectious agents1,3 - the doctor takes this important fact into account when choosing an antibiotic for the treatment of sore throat. In adults, tonsillitis predominates, caused by adenoviruses, rhinoviruses, coronaviruses, influenza and parainfluenza viruses. Streptococci join in the second stage of disease development1,3.

Infection occurs through airborne droplets, through kissing, through the use of shared dishes, towels, and household items. In the presence of foci of chronic infection and carriage, endogenous pathogens1,2 are activated, those that already live in the body. Thus, in 75% of cases, the culprits of exacerbation of chronic tonsillitis are bethemolytic streptococci that inhabit the crypts of the tonsils1.

The inflammatory process in the tonsils can be a consequence of some systemic diseases:

1. Infectious mononucleosis,
2. Agranulocytosis,
3. Leukosis4.

Damage to the lymphoid tissue of the pharyngeal ring is one of the first symptoms of these ailments. Therefore, treating a sore throat with home remedies without consulting a doctor is always a risky undertaking.

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What brand of sore throat remedy is better to choose?

There are a lot of companies supplying the Russian market and pharmacy chains with antibiotics, antihistamines, anti-inflammatory and immunomodulatory drugs. Their list is constantly expanding, as are new generations of drugs. Before looking for a reliable product for yourself, get acquainted with the reputation of its manufacturer.

The following companies were approved by experts:

• Obninsk Chemical and Pharmaceutical Company was founded in 1999 on the basis of a scientific institute. After the construction of workshops for the production of finished dosage forms, the range expanded significantly. The company was included in the list of the best high-tech fast-growing companies in the Russian Federation.
• Schering-Plough is an international company that has focused all its activities on an in-depth study of the market conditions for therapeutic programs. Founded in 1971, in recent years the brand has been recognized as a leader in biotechnology.
• Egis is a Hungarian pharmaceutical plant that annually replenishes pharmacy chains around the world with antihistamine, antibacterial, and cardiovascular drugs. Successful activities have been going on for about 10 years, and regularly 9% of profits go to scientific development.
• Pliva is a Croatian pharmaceutical company, a leading supplier of pharmacies in Central and Eastern Europe. The main part of the products are successful generics of the world’s “blockbusters” in the field of medicines, which became famous thanks to effective forms of Adderall.
• Lek is a Slovenian company founded in the 40s of the last century. After some time, she joined the Swiss company Novartis, which provided access to the world market. In terms of volume of products sold today, Lek ranks 1st in the United States.
• GlaxoSmithKline is an English company formed in 2000. Today it is the largest supplier of quality patented medicines in the world. In the pharmaceutical business, it is a leading player with an important mission - improving the quality of life of humanity.
• Pharmstandard is the largest and most influential Russian manufacturer of medicines. More than 1.7 billion packages are produced annually; these are safe, high-quality products that meet the standards of pharmaceutical practice.
• Aziende Chimiche Riunite Angelini Francesco Roma is an Italian pharmaceutical company that has been operating for 100 years. Today, this brand works closely with the international company Red Cross, providing high-quality effective medicines to different segments of the world's population.
• Anzhero-Sudzhensky HFZ is a Russian company that produces analgesics, anticonvulsants, bronchodilators and other drugs, including vitamins. The winning advantage lies in affordable prices and a strategy for promoting innovative drugs.
• Bayer is a famous German brand founded in 1863. The original drugs that made this name famous were Aspirin and Heroin. The company has expertise in the field of natural sciences, which is unofficially considered an indicator of high quality.
• Reddy's is an Indian pharmaceutical company founded in 1984. Today, it is not only a supplier of inexpensive, effective generics, but also has its own patented products and provides services.
• Reckitt Benckiser is a British company that is today a world leader in the development and sale of medicines, hygiene, health, and household products. The main task is to introduce innovations to improve the quality of life. The RB portfolio offers 19 brands.
• Laboratoires Bouchara – Recordati is a French company founded in 2000 through the merger of two companies, Recordati from Italy and Bouchara from France. The goal is to produce finished medicines of the gastroenterological, cardiological, antimicrobial, urological groups, as well as analgesics.
• Bosnalek is an international company with offices in many countries. It produces drugs from the fields of cardiology, neurology, gastroenterology, dermatology, otolaryngology, and pediatrics. Successful activities have been carried out since 1951.

Rating of remedies for sore throat

To treat such a complex disease as sore throat, doctors usually prescribe a whole range of drugs. Much depends on the etiology, symptoms, type of pathogen, course and possible complications. Experts studied and tested certified antibiotics, anti-inflammatory and antiallergic agents, antiseptics, and immunomodulators. The rating includes the best remedies for sore throats that are recommended by medical specialists, as well as the patients themselves, who assessed their effectiveness from their own experience.

The following criteria were also taken into account when selecting nominees:

• The cause of sore throat is bacteria, viruses;
• The severity of the course is the stage of the inflammatory process;
• Symptoms – signs, complications;
• Special instructions, conditions - contraindications, side effects;
• Release form: tablets, solutions, sprays, lozenges;
• Toxicity level – the lower the better.

The main rule of choice for such a disease is a doctor’s prescription. Many people look at the country of origin and price, so those options were selected that best cope with their tasks, with minimal impact on the digestive organs and general health.

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Complications with purulent sore throat

The disease is dangerous due to its complications, which can affect not only the respiratory system, but also spread to other human organs.

One of the common pathologies is the transition from an acute form of the disease to a chronic form (chronic tonsillitis). In chronic tonsillitis, inflammation is constantly present in the tonsils, and exacerbations occur 2-3 times a year, and in severe cases, more often.

Delayed treatment of the disease can lead to inflammation of the heart muscle (myocarditis), joint diseases (rheumatoid arthritis) and kidneys (glomerulonephritis and pyelonephritis). It is possible that a sore throat may develop into an abscess. This happens when the infectious pathogen has little space in the thickness of the palatine tonsil, and streptococcus begins to look for new sites for itself. Thus, inflammation can move to the paratonsillar and parapharyngeal tissue and provoke a paratonsillar or parapharyngeal abscess.

The pathologies listed above are powerful arguments for promptly starting treatment for purulent tonsillitis.

The best antihistamines for sore throats

Often the doctor’s list of medications for angina is supplemented with antihistamine medications. They act as an auxiliary therapy to relieve unpleasant symptoms of the disease - swelling of the larynx, allergic reactions to other medications. Anti-allergy tablets are distinguished by composition and different generations. Experts compared several dozen items from different pharmaceutical companies, choosing the best nominees based on price, effectiveness, safety, medical recommendations, and patient reviews.

Diazolin

The most common antiallergic drug in the Russian Federation for many years is Diazolin. Its job is to suppress the hormone histamine. Manufacturers offer a new generation of Diazolin, the correct use of which guarantees the relief of spasms and blocking of receptors in the bronchi, vascular muscles, and smooth intestines. The main component in the composition is mebhydrolin. Minimal toxicity and safety allow the tablets to be taken even by children aged 3 years and older.

Advantages

• There are no strict age restrictions;
• Low price;
• Wide availability;
• Low level of toxicity;
• Quick impact;
• Long lasting effect.

Flaws

• There are contraindications and risks of side effects;
• May cause drowsiness.

Judging by the reviews of patients, the tablets help overcome swelling due to inflammation of the respiratory mucosa. Despite their low price, they cope well with all manifestations of allergies, but can cause temporary drowsiness, which is undesirable for drivers.

Claritin

Another new generation antihistamine that acts on histamine receptors. On sale you can see 2 forms - syrup, tablets. Compared to many analogues, the main component loratadine will act much longer. 30 minutes after administration, the pain subsides, and further assistance may be needed only in a day. After it there is no drowsiness, bitterness, dry mouth, or inhibition of reactions. Children can take Claritin starting from 2 years of age, the dosage is calculated based on body weight.

Advantages

• Ease of administration;
• Long-term activity of the active substance;
• Lack of drowsiness, inhibition of reactions;
• No effect on the nervous system;
• Versatility;
• No addiction.

Flaws

• The cost is higher than analogues;
• Insignificant therapeutic effect in some cases.

Judging by the reviews, imported Claritin demonstrates better effectiveness in comparison with Russian analogues. The therapy does not affect a person’s activity, which is important for drivers.

Suprastin

The most powerful antiallergic option in this category of medications is Suprastin, where the main component is chloropyramine. It guarantees a quick effect within a few minutes after administration, while it does not linger in the blood or cells, and is almost completely eliminated from the body by urine. In addition to suppressing allergic reactions, Suprastin also works as a sedative, calms, relaxes, and causes drowsiness. Prescribed for complex cases of the disease, when emergency support of the body is needed.

Advantages

• Proven effectiveness;
• Antihistamine, sedative effect;
• Low price;
• Fast, long-lasting effect;
• Help with severe allergies.

Flaws

• Severe drowsiness;
• Slow reactions.

Such a powerful antiallergic drug is not prescribed to drivers, small children, or pregnant women. Compared to previous options, it has a longer list of contraindications and risks of side effects.

Symptoms of a sore throat

The acute form of tonsillitis is accompanied by the following symptoms:

• Severe redness of the throat;
• Pain when swallowing;
• Feeling overwhelmed, severe weakness;
• Increased body temperature;
• Induration, tenderness of the lymph nodes;
• Headache;
• Bad breath;
• Aches in muscles, large joints;
• Increased size of tonsils;
• Decreased physical activity and performance.

In adults, the symptoms of sore throat are milder than in children. As a rule, without high temperature. Recovery, subject to medical recommendations and effective local treatment, occurs in 5-10 days. If recovery does not occur, then the time has come for chronic tonsillitis.

If tonsillitis occurs frequently, you need to visit a rheumatologist and cardiologist to rule out damage to the heart and joints2,3.

Chronic tonsillitis occurs without pronounced symptoms. Patients complain of discomfort in the throat and bad breath. Sometimes an obsessive dry cough occurs. Some people have a low-grade fever (37-38 C°) for a long time, sweating and weakness.

Chronic tonsillitis leads to hypertrophy of the tonsils and a decrease in their protective functions.

As a result, general immunity is weakened, which can provoke the development of severe infectious diseases4.

The best antibiotics for sore throat

If the disease is caused by pathogenic bacteria, treatment is accompanied by antibiotics. Experts familiarized themselves with doctors’ recommendations on how to treat purulent tonsillitis of bacterial etiology, test results, and medical statistics. No less important were the reviews of patients who rated the speed, safety, price and quality, after which the best antibiotics for angina were named.

Sumamed

The great popularity of this remedy is due to the fact that it is a broad-spectrum antibiotic. This means that its main component, azithromycin, will cope with most bacteria and strains. Belonging to the group of macrolides, it first destroys the protein shell of the pathogen, and this already leads to their death. It demonstrates maximum effectiveness against gram-positive flora. It is important to complete the course of therapy, even if there are improvements.

Advantages

• High activity;
• Short course, ease of use;
• Good treatment of specific forms of sore throat;
• No allergic reactions;
• Good tolerance.

Flaws

• Price;
• Contraindications, side effects.

Despite the good performance indicators, this antibiotic should not be taken during pregnancy or lactation. They also approach treatment with great caution in case of serious pathologies of the kidneys and liver.

Doctors emphasize that, unlike many modern antibiotics, Sumamed copes even with the mycoplasma, chlamydia form of the disease.

Amoxiclav

This antibiotic belongs to the group of penicillins, which are widely used in the treatment of many diseases. The composition contains not only the active component amoxicillin, but also clavulanic acid, which destroys the protective shell of pathogenic bacteria. This provides a 100% guarantee of destruction of the sore throat pathogen. The semi-synthetic composition protects the digestive organs from the negative consequences of such therapy.

Advantages

• Rapid penetration into the lesion;
• No age restrictions;
• Various release forms;
• Lack of relationship with food intake;
• Effective against gram-positive/gram-negative bacteria;
• Low price.

Flaws

• Short shelf life;
• Frequent use of tablets/powder.

Such an effective remedy for sore throat belongs to the latest generation of antibiotics, since in any case the bacteria will not be able to develop resistance to the active component. Quick help is guaranteed even with purulent forms of the course with complications. If powder is used to prepare a suspension, the shelf life is 1 week.

Augmentin

Augmentin is similar in composition and effectiveness against pathogenic bacteria. It also contains amoxicillin and clavulanic acid. Due to this, it is widely used in medicine against various diseases. The difference from the previous nominee is the price, as well as the manufacturer. Augmentin is produced by a British company with a high rating on the market. And since it is semi-synthetic, it protects the intestinal microflora from disturbances and healthy tissues from damage.

Advantages

• Selective bactericidal effect;
• No age restrictions;
• High effectiveness of therapy;
• Performance;
• Ease of use;
• Reliable manufacturer.

Flaws

• The importance of correct dosage calculation;
• Risks of side effects.

This is not a cheap antibiotic, as it is produced by a well-known European company. But the price is fully justified by its low toxicity. According to reviews, side effects occur extremely rarely and are most likely due to negligence in the instructions. Treatment of sore throat with antibiotics will be safe for the intestines only if the doses are observed.

Azithromycin

Belongs to a new generation of macrolide antibiotics. Suitable for purulent forms of the disease, chronic course. It is important to select the dosage correctly, and most importantly, not to stop treatment even if you feel better. But usually the course is only 5-7 days, which is very convenient. It demonstrates maximum effectiveness against gram-positive bacteria. It is a complete analogue of Sumamed, but is produced by other manufacturers.

Advantages

• Good safety profile;
• Efficiency;
• Convenient reception;
• Stable antimicrobial activity;
• Good compatibility with other medications;
• High activity at the site of inflammation.

Flaws

• It is not advisable to take capsules with food;
• Contraindications, side effects.

For each patient, the doctor must individually calculate the optimal dose, taking into account the stage of the disease. In general, reviews confirm that correct use of capsules/tablets rarely causes unpleasant symptoms or dysbacteriosis. But for children, this form of release is not entirely convenient; the manufacturer did not provide powder for suspensions.

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Complications of sore throat

During the disease, the infection can spread to neighboring organs, causing otitis media, lymphadenitis, sinusitis, and peritonsillitis. Among the local purulent complications of tonsillitis, one can note the formation of an abscess or phlegmon in the inflamed tissues. Their occurrence is accompanied by a new wave of fever, increasing sore throat, problems with swallowing and breathing. In the case where the pathology is caused by streptococcus, 3-4 weeks after clinical recovery, glomerulonephritis, reactive arthritis or rheumatic carditis may develop due to subsequent autoimmune processes.

The best lozenges and sprays for sore throats

The last category in the ranking is effective topical preparations. We are talking about antimicrobial lozenges, lozenges, and antiseptic sprays. They can be used independently at the initial stage of the disease, as well as in combination with other medications in severe cases. Experts selected the most popular, according to reviews, safe, effective according to doctors’ recommendations, modern lollipops and sprays.

Strepsils

The most popular drug for reducing sore throat is Strepsils lozenges. The anesthetic effect is guaranteed by lidocaine in the composition, and 2,4-dichlorobenzylethanol, amyl methacrysol acts as an antimicrobial agent. Thanks to this composition, in pharmacology Strepsils is classified as a fungicidal, antibacterial medication with local action. Resorption of no more than 8 lozenges per day is permissible.

Advantages

• Quick relief from sore throat;
• No contraindications or side effects;
• Suppression of inflammation;
• Pleasant taste;
• No sugar, suitable for diabetics.

Flaws

• Dye, flavoring in the composition;
• Temporary effect.

Reviews confirm that the lollipops quickly eliminate the unpleasant symptoms of the disease, but act temporarily. This means that they cannot be used as an independent medicine, but rather as an addition to a set of measures. As for use in children, doctors do not recommend giving Strepsils to those under 5 years of age.

Tantum Verde

A popular modern remedy for relieving the symptoms of sore throat. Available in the form of a liquid solution intended for gargling. The composition contains antiseptics and analgesics, which means that after use you can expect pain relief and suppression of pathogenic microflora. That is, Tantum Verde not only makes you feel better, but also, penetrating into the tissue, eliminates the root cause.

Advantages

• Suppresses inflammation in the initial stages;
• Fights the root cause of the disease;
• Minimally toxic;
• No strict contraindications;
• Convenient form of application.

Flaws

• Price;
• It is not always convenient to gargle.

In the reviews you can see that Tantum Verde helped many to suppress inflammation without antibiotics and other drugs. But this is only possible if rinsing is performed immediately after the first warning signs. You should not expect the solution to perform impossible tasks if we are talking about a disease with fever, inflammation, or complications.

Hexasprey

A well-known French antiseptic for topical use, which is actively used by otolaryngologists. It is produced in the form of an aerosol spray, which allows it to be evenly distributed over the mucous membrane of the throat, tonsils, and palate. The main substance in the composition is biclotymol, which penetrates into the shell of pathogenic microorganisms, leading to their destruction. This means that in the early stages Hexasprey can be an excellent alternative to antibiotics.

Advantages

• Convenient release form;
• Destroying the root cause of the disease;
• Wide scope of application;
• Fighting sore throat symptoms;
• Large irrigation area;
• Safety, minimum contraindications.

Flaws

• Price;
• Not always available at pharmacies.

If Hexasprey is used in a timely manner, it will be effective against infections, bacteria, and viruses. Doctors note that it works well as an analgesic and anti-inflammatory drug. But not every pharmacy has it in stock, and European production will cost more than its domestic counterparts.

Lysobacter

Effective antiseptic for local use. Prescribed most often for infectious inflammation in the upper respiratory tract. Available in the form of lozenges, the active substances include pyridoxine and lysomycin. Accordingly, Lyzobact is natural, safe, with a minimum number of contraindications and side effects. Correct use guarantees a complex effect - suppression of fungi, bacteria, infections, elimination of pain, swelling, and inflammation.

Advantages

• Natural composition;
• Eliminating the source of the disease;
• Allowed during pregnancy, children over 3 years of age;
• Restoration of nasopharyngeal microflora;
• Elimination of symptoms of the disease.

Flaws

• Inadmissible for lactase intolerance;
• Requires a long stay in the oral cavity.

Unlike many of the nominees described, Lizobact has no side effects, except for a possible allergic reaction. The reviews emphasize that for maximum effectiveness of treatment, the tablet must be dissolved for as long as possible (about 1-1.5 hours).

Possible complications

Tonsillitis can cause local complications1,2:

• the formation of a paratonsillar abscess, characterized by severe intoxication, unilateral sore throat, bulging of one gland, deviation of the tongue towards the affected side, inability to fully open the mouth, forced tilt of the head towards the abscess;
• otitis media, or inflammation of the middle ear, accompanied by pain, congestion and a feeling of pressure in the ear, and in the absence of treatment - labyrinthitis (damage to the inner ear), manifested by tinnitus, nausea, vomiting, dizziness and a disturbance in the sense of balance.

Without treatment, catarrhal, follicular or other sore throat in adults and children can lead to the development of diseases such as1,2:

Most often, such complications occur in people who have advanced the disease, consulted a doctor late, or did not receive treatment at all1.

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What is the best remedy for sore throat?

The choice of drugs for the treatment of tonsillitis, pharyngitis and other forms of sore throat must be approved by a doctor. All nominees presented in the rating received the best recommendations from otolaryngologists. The decisive factors are the degree of development of the disease, its root cause, symptoms, indications and contraindications. From the description of each review position, pros, cons, features, the following conclusions can be drawn:

• The safest, most effective antibiotic for adults is Augmentin;
• The most effective, fast-acting antibiotic for children is Sumamed;
• The best local analgesic effect is Strepsils;
• The best local antiseptic is Tantum Verde;
• The most powerful non-steroidal anti-inflammatory drug is Ibuklin;
• The best antihistamine for angina of various etiologies is Diazolin.

The compiled rating is the people's choice, confirmed by medical specialists and experts. He will help you narrow down your search and tell you which medicine is worth buying for a full recovery. Consultation with a doctor before starting home therapy is required.

Diagnosis of sore throat

At the patient’s initial visit, the doctor collects complaints and anamnesis, specifying the duration and circumstances of the onset of symptoms, and the nature of the pain.
This is followed by a general examination of the patient, a visual assessment of the mucous membranes of the mouth and throat, and palpation of regional lymph nodes. An endoscopic examination of the ENT organs – pharyngoscopy – is mandatory. It allows you to examine the tonsils in detail and thus determine the form of the disease. For angina, the following tests are prescribed:

1. Clinical blood test. Inflammation is indicated by neutrophilic leukocytosis with a shift to the left and accelerated ESR.
2. General urine analysis. It is possible that protein may appear in the biomaterial.
3. Rapid test from the tonsils using diagnostic strips to detect group A beta-hemolytic streptococcus.
4. Bacteriological examination of a smear for beta-hemolytic streptococcus and diphtheria. Material is collected from the surface of the palatine tonsils and the posterior wall of the oropharynx before using local antiseptic drugs and taking antibiotics.
5. If a patient is suspected of having infectious mononucleosis, a blood test is performed to test for IgM antibodies or to identify the genetic material of the Epstein-Barr virus.
6. As part of the diagnosis of herpetic sore throat, enterovirus RNA is determined in the blood and throat smear using the PCR method.

Diagnosis of complications of angina after clinical recovery includes the following laboratory and instrumental studies:

1. Control general analysis of blood and urine.
2. Rheumatic test. Determination of rheumatoid factor, C-reactive protein, antistreptolysin-O, seromucoid in the blood.
3. ECG. The electrocardiogram may show signs of hypoxia and conduction disturbances.