Recurrent tonsillitis and swelling in spite of antibiotics.

Resolved question:

My tonsils are infected and it has become really painful. Besides, it gave rise to high fever (102.2 F). I don't have any other symptoms. I can eat well and no headaches, sneezing, ache or pain. With advice from a local md I first used paracetamol and amoxicillin but they didn't work. Then we made blood test and my granulocyte and sedimentation levels were high. Therefore the local md thought the infection is bacterial, not viral. He asked me to use cephalexin, ornidazole and metamizole sodium. It solved the fever problem but my tonsils are still very painful and big. Besides when I stop using metamizole sodium the fever tends to reappear. I would be glad if you may help me on this point.

Submitted: 4 Days
Category: Community

Expert:  Dr. John Monheit replied 4 Days.

Hello,

It seems to me like a case of acute tonsillitis with peri tonsillar abscess.

Acute Tonsillitis is a very important cause of morbidity among young adults like you and is almost always bacterial. As amoxicillin didn’t relieve the symptom, I think it is due to a resistant variety of Group a Strep. Pneumonia.

As the bacteria was not removed initially, it has caused the infection of the tissue around the tonsil and formed and abscess. Abscess is a pocket of Pus and is acutely painful and can lead to spiking fever and swollen tonsils. They are resistant to many Antibiotics and require Broad spectrum antibiotic coverage and surgical drainage.

My recommendations would be-

1) Immediately get a surgical consultation, who will determine if the abscess needs surgical drainage or per-coetaneous drainage.

2) You need to be started on broad spectrum antibiotics like Cefepime. Avoid alcohol consumption during Cefepime, cephalexin and ornidazole treatment as it can cause severe reactions.

3) Use warm compresses externally in the cheek for better resolution of the abscess.

Thank you.

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