The Altons at Doom and Bloom Medical have a short article on Tonsillitis in Austere Settings.
Your tonsils are glands on each side of the back of the throat. Their job is to help trap bacteria and other germs that cause infections. Sometimes, however, they can become infected themselves, a condition known as “tonsillitis“. Most cases of tonsillitis are caused by viruses, but bacteria may also be the culprit. The average age is between 5 and 15 years old.
Once, tonsils were commonly removed (known as “tonsillectomy”) in young children at the first sign of infection. In the 21st century, the procedure is much less common. Recurrent bacterial infections or severe symptoms may still require removal, a simple procedure (see link) in the hands of an experienced provider, but difficult for the family medic. The best option, therefore, in austere settings is identifying and treating as early as possible.
(Note: I had my tonsils removed at age 5. At least they gave me some ice cream afterwards! Joe Alton, MD)
Use of a tongue depressor helps visualize the area. Common signs and symptoms of tonsillitis include:
• Red, swollen tonsils
• White or yellow coating or patches on the tonsils
• Sore throat
• Difficult or painful swallowing
• Enlarged, tender glands (lymph nodes) in the neck
• A scratchy, muffled or throaty voice
• Bad breath
Since tonsillitis is often seen in children too young to give a good history, look for:
- Loss of appetite
- difficult or painful swallowing
- Drooling or difficulty breathing (signs of a severe case)
Treating someone with tonsillitis can include some of the following:
- A soft diet
- Saltwater gargles
- Throat lozenges
- Acetaminophen or ibuprofen is helpful for pain, but aspirin should be avoided in children due to Reye’s Syndrome.
Although viral tonsillitis isn’t improved with antibiotics, Penicillin or amoxicillin works for bacterial infections if taken by mouth for ten days. If Penicillin is not an option due to allergy, azithromycin may be substituted. These drugs are available in veterinary equivalents at fishmoxfishflex.com.
- Amoxicillin 500-875 mg orally twice a day or 250-500 mg orally every 8 hours for 10 days
- Penicillin V 500 mg orally twice a day for 10 days or 250 mg orally four times a day for 10 days
- Azithromycin 500 mg orally once a day for 5 days
- Penicillin V 25-50 mg/kg/day divided by four and given every 6 hours for 10 days
- Amoxicillin 50 mg/kg/day orally in 2 or 3 divided doses for 10 days
- Azithromycin 12 mg/kg orally once daily for 5d
Joe Alton MD