Treatment of tonsilitis with antibiotics

The treatment of angina must not be underestimated in any case, it is necessary to avoid any kind of stress, including mental stress, in order to save our body as much energy as possible to fight against the insidious disease. First of all, we need to decide as soon as possible whether we will treat angina with antibiotics or without antibiotics. In addition to your doctor, the following information will hopefully help you to make the right decision.

As with any disease, a correct DIAGNOSIS is very important.
When a doctor suspects angina, in addition to a rapid streptococcal test (Rapid Strep A test), which takes a few minutes (but is usually not covered by the health insurance company, price approx. 50 CZK), he can have the laboratory precisely determine the cause of tonsillitis. The sample will later be microbiologically tested in a hospital laboratory to determine whether the inflammation is of viral or bacterial origin. Unfortunately, in routine practice, we face two main problems when diagnosing angina:

1. General practitioners often do not perform a swab at all and prefer to prescribe antibiotics straight away. In such a case, it is enough to ask the doctor to perform the swab, it is a simple and painless operation and, including the subsequent analysis in the laboratory, is fully covered by the health insurance company. The use of antibiotics without an accurate diagnosis, so-called "just in case", can not only damage the patient's immunity, but also strengthen bacteria that survive imprecisely targeted antibiotic treatment. A report by the World Health Organization also warns against this threat.
2. Time delay between the swab and the result of the laboratory test. In the laboratory, the bacteria must be cultured, i.e. multiply in laboratory conditions in order to find out if and which bacteria are the cause of the disease, which usually takes 2 days. This is often too long, and in the case of aggressive strep throat, serious complications can occur during this time.

Therefore, it is necessary to proceed immediately with maximum caution and responsibility, i.e. bed rest and throat disinfection. If the laboratory proves within 2-3 days that the causative agent is indeed a bacterium, e.g. Streptococcus pyogenes, the patient can decide whether to start treatment with antibiotics or whether to continue treating angina without antibiotics.

The most effective antibiotic for streptococcal angina is Penicillin V or Erythromycin in patients with penicillin allergy. Antibiotics usually start working within 24 hours. If the patient is taking antibiotics, it is important to take them at set intervals and use the entire prescribed dose until the end of the treatment to prevent the bacteria from returning or multiplying.
Treatment of angina with antibiotics is undoubtedly the most common method of treatment, mostly effective, but having
A FEW DIFFICULTIES: 

1. If angina is caused by a virus and not a bacterium, then antibiotics are ineffective, unfortunately their use can only unnecessarily weaken our immunity and complicate the entire treatment. Our only weapon against viruses is our immune system, therefore a correct diagnosis and identification of the cause of the disease is absolutely necessary.

If the causative agent is a virus, it is undesirable to weaken the immunity with antibiotics, on the contrary, we must try to support the immunity, and the treatment of viral angina thus consists primarily of a sufficient supply of vitamins, rest, adequate control of the fever (that is, only if it is necessary, because the fever itself itself is one of the important tools of our immune system), drinking enough fluids, etc.
2. If angina is caused by bacteria that is resistant to antibiotic treatment. Unfortunately, the resistance of bacteria is starting to increase dramatically in recent years (see the report of the World Health Organization) and this also applies to the resistance of streptococcus. This fact significantly complicates the treatment of angina with antibiotics. If the treatment of angina with antibiotics is unsuccessful and the streptococcus survives it, the angina will return very quickly, despite the apparent cure, and the immunity weakened by antibiotics has significantly less power to successfully fight bacteria in the case of repeated angina.

The patient usually ends up in a vicious circle of repeated unsuccessful attempts to cure with antibiotics. It is very difficult to get out of this circle, and often the solution is the removal of the tonsils, the so-called tonsillectomy, which is, however, a rather questionable procedure from the complex point of view of 21st century medicine.

Bacterial resistance in angina usually does not mean that antibiotics would not work at all. Rather, it is common that antibiotics improve our condition relatively quickly and significantly suppress bacteria. The problem, however, is that they cannot kill them 100%, the bacteria then remain in our body and at the earliest possible opportunity, usually within a few days or weeks after the antibiotics have been taken, they will cause a new acute angina.

Also according to the statement of the State Health Institute of the Czech Republic, out of a whole range of factors considered, such as insufficient dose or duration of antibiotic administration, local factors in the affected tissue, survival of streptococci in the affected tissue, tonsil cells or crypts, the susceptibility of the individual, etc., the most significant phenomenon is the persistence of a small of the number of cells in the resting stage of division. Therefore, a control examination after the end of treatment can show the presence of streptococcus of the same type in about 5% of cases. It is usually impossible to distinguish whether it is a reinfection or a survival of the original strain. If there has been a recurrence of the disease with a new presence of streptococci and there is a special reason for a new attempt at eradication, repeated administration of penicillin is recommended.

If the streptococci "survive" even the second antibiotic, according to experience, there is only a small hope of success if the third antibiotic is administered. At the same time, it is likely that from the beginning they were carriers and diseases caused by another pathogen. But even if the original disease was streptococcal, after two treatment attempts, the risk of late consequences and contagion for the environment has subsided to such an extent that there is no longer a reason for further intervention.

In addition to this failure to eradicate streptococci, however, the administration of antibiotics also has serious risks for individuals, i.e. the elimination of the normal microflora, which includes a whole range of bacterial genera and species producing substances and containing structures that protect against the strain's attachment to the mucosa, which is the first step allowing the following phases to follow disease development.
In the case of recurring acute or chronic angina, the attending physician will most likely sooner or later recommend the aforementioned tonsillectomy (removal of the tonsils). However, it is necessary to take into account that even the tonsils have their important function and before we allow them to be torn out, which is irreversible, it is worth trying to save them by all available means.