Tonsillitis and pharyngitis are the infections of the throat and when it is mainly the tonsils that are inflamed, it is usually referred to as tonsillitis. However, it is not impossible to have both the tonsils and the throat to get inflamed and because of the tonsils reside in the pharynx, the term pharyngitis is interchangeable. Acute pharyngitis is mostly viral in origin and can be self-treated.
The rest is due to bacteria in which it accounts for 15 – 30% of cases among children and 10% of cases in adults. Most of the bacterial pharyngitis is secondary to Group A β-Hemolytic Streptococcus (GABHS) or Staphylococcus pyogenes in which it is most effective when treated by antibiotics. So, there will be strict precautions when giving antibiotics to patients to prevent the emerging trend of antimicrobial resistance.
In addition to that, by giving proper antimicrobials, it can prevent the attending immune complications by an infection such as rheumatic fever, rheumatic heart disease, and post-streptococcal acute glomerulonephritis. Some of the types of tonsillitis are catarrhal, parenchymatous, follicular and membranous tonsillitis. Catarrhal tonsillitis is usually characterized by an inflamed overlying mucous membrane and the tonsils may not be enlarged. When the tonsils are diffusely enlarged it is usually due to parenchymatous tonsillitis. Follicular tonsillitis is characterized by yellowish spots with normal intervening mucosa and due to the infection that resides in the crypts of the tonsils, it is usually filled with pus. The membranous tonsillitis is the last stage of follicular tonsillitis and the crypt exudates coalesce on the surface of the tonsils to form a membrane. Patients usually presented with symptoms of sore throat, pain on swallowing, high-grade fever with chills, pain in the ear and painful neck swelling. Doctors usually find the patient to have fetid breath, coated tongue, hyperemia of the soft palate, uvula and anterior pillars and tonsils appearing red and swollen with the specific features of each type of tonsillitis.
It is important to refer to an ENT (Ear, Nose & Throat) specialist when patients suffered from recurrent acute tonsillitis, chronic tonsillitis, symptoms of Obstructive Sleep Apnea (OSA), unilateral tonsil enlargement and complications of tonsillopharyngitis. The throat culture is recommended in an outbreak situation for the epidemiologic studies. The modified Centor score is useful for doctors to determine which kind of investigation is to be used (throat culture/ rapid antigen detection testing, or empiric treatment with antibiotics) or if there is no investigation is required at all. Tonsillitis treatments in Malaysia started when bacterial pharyngitis is suspected. The first choice of antimicrobial that is being used is the penicillin and for patients who are allergic towards it, erythromycin is being used instead.
For GABHS infection, penicillin V is being used in a 10-day course but in some cases, amoxicillin is being used instead because of its availability, taste and the increased likelihood of compliance. The erythromycin resistance rates are low and there is no evidence suggested that the GABHS having resistance or tolerance towards penicillin. In addition to that, patients with pharyngitis should be offered an appropriate dose of antipyretics and analgesics apart from other supportive care.