Treatment of Angina

Tonsilitis

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.

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Treatment with 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 POTENTIAL:

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 oral 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 in the neck 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.

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Treatment without antibiotics

With the increasing resistance of bacteria to antibiotics, the need to treat angina without antibiotics also increases.
We recommend reading the experiences of patients at angina.cz and streptokill.info, where dozens of posts are related to this topic.

We believe that these practical experiences will be a source of valuable information for you and we welcome your experience as well.
The advantage of treatment without antibiotics is that the immune system is not devastated by antibiotics, and the patient has a significantly better chance that acute angina will not return after treatment. If the tonsils are heavily affected by previous inflammations, then of course the return of angina is not an exception even in the case of a cure without antibiotics, but unlike angina, which returns after antibiotics, the patient usually manages it better.

The disadvantage, on the other hand, is that there is a higher risk of the so-called sterile consequences of bacterial infection during treatment without antibiotics (more below, see Complications), which are very rare, but should be mentioned here.

DISINFECTION OF THE THROAT IS ESSENTIAL FOR EACH UNUSUAL SENSATION IN THE THROAT

Scratching the throat is very common, especially in people who have tonsils in a bad condition. Especially such patients use Streptokill quite often at first, because with tonsils that are in a bad condition, "scratching in the throat" is almost a daily occurrence, although it does not always have to mean the onset of angina. However, this is not essential for treatment without antibiotics. Whether the cause of the inappropriate sensation in the throat is bacteria, a virus, mechanical damage or just a false sensation, there is no need to address the cause and Streptokill should be applied without delay.

As can be seen from the experience of patients, with proper and long-term care for the disinfection of the throat in a natural and non-chemical way, the condition and function of the tonsils gradually improves, the "scratching in the throat" does not occur as often and thus the frequency of Streptokill use also decreases.

If the scratch in the throat is caused by a virus and not bacteria, then of course disinfection of the throat does not play as important a role as in the case of a bacterial agent, but we will not harm anything. Especially because secondary or the subsequent product of a viral infection is usually a bacterial infection. Moreover, unlike antibiotics, which are ineffective against viruses, we do not weaken the immune system.

In the case of viral angina, it is necessary to rely primarily on one's own immunity and support it with sufficient rest, supply of fluids, vitamins in natural form and adequate control of fever. We do not recommend artificially produced vitamins, as well as reducing an elevated temperature with medication. Fever is a natural weapon of the immune system and if it is not so high that it threatens our life, then we should let it fulfill its function. It is necessary to realize that increasing natural immunity is not about tablets and artificial preparations, but quite the opposite about finding a balance and a way to what has been inherent to the human organism since ancient times. It is almost impossible to have a strong natural immunity if we excessively consume artificial preservatives, dyes, synthetic drugs and other substances that are not natural for our body. In combination with an unhealthy lifestyle full of stress, staying in air-conditioned or overheated rooms and a lack of movement in the fresh air, we cannot be surprised at the increasing statistics of chronic diseases of any kind.

COMPLICATION

If the treatment is ineffective, angina can spread to the tonsils or pharynx. Sometimes the tonsils can become so significantly enlarged that the airways can be blocked or an abscess can form, a sac full of pus, which must be surgically cut open and suctioned out, possibly removed together with the tonsils, a so-called tonsillectomy.
In streptococcal angina treated without antibiotics, there is a greater risk of the so-called sterile consequences of the bacterial infection, i.e. those that arise only after the streptococcus is usually no longer present at all, e.g. several weeks after suffering from angina. It can be inflammation of the kidneys or rheumatic fever, which affects, for example, the heart valves, the heart muscle or the skin. The causes of rheumatic fever are not completely known, it may be largely an autoimmune disease. But these serious complications are very rare.

If the patient wants to make sure that his angina is treated correctly and to minimize the risk of complications after suffering a streptococcal infection, he can ask the doctor to check the urine and blood after suffering from angina, although the examinations may not always be clear. Blood sedimentation decreases relatively slowly after angina, the values of antibodies against Streptolysin (so-called ASLO), a poisonous protein produced by Streptococci, increase even more slowly. Many people have this value elevated for a long time without suffering symptoms of inflammation.

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Pediatric treatments

In childhood, angina is usually more common than in adulthood. The reason is the more frequent stay and closer mutual contact of children in groups, when angina can ideally spread, but also the development of the tonsils themselves, which gradually increase from birth, reach their maximum size around the seventh year of life, and then slowly begin to shrink.

DIAGNOSIS
Establishing the correct diagnosis can be a little more problematic, especially in young children, than in an adult who can accurately describe his condition. In addition, there are many children's diseases, but not only children's diseases, which can have similar symptoms to angina. However, the doctor should not have any major problems with the diagnosis, and if he could not establish it with a simple examination, he can determine it with the help of various examinations available to him. Directly in the doctor's office, it can be, for example, a CRP test showing inflammation in the body, a rapid Streptococcal test or other tests that are done in collaboration with a laboratory or specialists, such as microbiological, biochemical, blood count, sonography, serology, allergology, X-ray and others .

However, the most common cause of angina in children is, like in adults, pyogenic streptococcus (streptococcus pyogenes), which is also often called the scarlet fever bacillus, due to the fact that a frequent accompanying phenomenon in childhood streptococcal angina is fever or heat rash. It is actually secondary or a subsequent product of streptococcus and usually appears a few days after angina, which we also call febrile angina accordingly. It is a common streptococcal sore throat, which is also followed by a fever rash.

SYMPTOMS and TREATMENT

They are basically the same for children as for adults, with the difference that an adult has a lot of experience, so he often guesses well whether he has the flu or a sore throat, he himself is responsible for this supposed diagnosis, so he can "prescribe" himself the treatment he is looking for convinced that it is correct and if it does not work, then go to the doctor. However, we should not apply this procedure to children and should not unnecessarily delay a visit to the doctor. Of course, there are certain thresholds between which we can best move in cooperation with the doctor, so we can usually get the pediatrician to agree that we will reduce the fever, e.g. only if it exceeds a higher limit than normal, that we will not give corticoids, that we will try treatment without antibiotics, etc.

REMOVAL OF TONSILS, so-called TONSILECTOMY

It is a procedure that is even more controversial in children than in adults. It should really be the last choice, as we are deciding whether or not to let our child have an organ that nature created not just for decoration, but as an important part of the immune system, removed forever. Sometimes the doctor is so persuasive and the parents are so desperate that they don't have the strength to look for other solutions, but that's definitely a mistake! Before we decide on this irreversible procedure, all solutions should really be exhausted, including, for example, taking the child to the Canary Islands for 3 months outside the usual school community and in an environment saturated with sea salt. If this, for example, in combination with Streptokill helps, then it is clear that the problem is elsewhere than in the tonsils, and leave the child's tonsils. They have a relatively significant ability to regenerate, even though many doctors deny this and say that the tonsils are irreversibly severely damaged. However, this is not true even in adults, let alone in children, where the tonsils are still developing.

LITTLE CHILDREN UNDER 3 YEARS

In infants, classic streptococcal angina is relatively rare.
In younger babies, white plaques in the mouth will be more likely to be thrush, or thrush, or candidiasis, which is a yeast infection.

Viral inflammations, which can be very painful, are much more common in older infants and children around one year than streptococcal angina. Of course, we cannot expect children this young to tell us that they have a sore throat, but rather to suffer from anorexia and refusal of liquids. In short, they won't want to swallow because it will be painful for them. Alternatively, they will cry while swallowing and vomiting may also occur. You have to be patient, we can try a liquid diet, such as various porridges or mixed non-irritating foods.

If it is an infant, then of course we do not stop breastfeeding, which not only helps with hydration and feeding, but also calms the child. As with adults, children also have very good experiences with the application of Streptokill. For children under 3 years of age, however, you should consult with a pediatrician before using it, because it contains alcohol, although its amount is very small (one dose contains only 0.1 ml of 58% alcohol, 15 injections therefore correspond to approx. a tablespoon of beer, which there is a sufficient amount of Streptokill for the whole day in the smallest children). An indisputable advantage of Streptokill is the fact that it is sold as a spray with an oral applicator, which is ideal considering that small children cannot gargle and sucking would pose a suffocation risk. The applicator is enough to reach the back of the mouth (which can sometimes be a problem, because even small children can refuse, especially if after the first application they experience a burning sensation, which is common with an infected throat and usually lasts a few seconds, also see patient experiences ) and Streptokill spread over the tonsils and the back of the larynx will occur spontaneously or until the child swallows.

LITTLE CHILDREN UNDER 4 YEARS

Kindergarten and school children are the most common cases of recurrent angina. The tonsils at this age go through a stormy development, but above all we have to realize that angina is an infectious disease that is relatively easily transmitted in a large and highly contact group of children. Minor epidemics in children's collectives are therefore no exception. If the child is unlucky, then he has among his friends a bacillus carrier who transmits streptococcus in the group, even if he himself does not suffer from any symptoms. Unfortunately, such a situation is difficult to solve, because in practice it is not realistic to have the presence of streptococcus detected in healthy classmates and force them to be treated with antibiotics, when in fact they themselves do not suffer from any disease. If the child wants to stay in such a group, we again highly recommend STREPTOkill along with strengthening their own immunity (healthy diet, longer stay by the sea, regular exercise in nature) so that the child can better deal with the infection.

Although there are other methods, such as long-term antibiotic crusts (suspended storage, etc.), they are a very controversial solution, because they significantly and above all advance the functioning or non-functioning of the child's natural immunity and, in essence, of the child's natural behavior as such, because they are also related to a long-term rest regime, which is in direct contradiction to a healthy lifestyle. In short, being under the permanent influence of penicillin for half a year without any guarantee that in the next six months the patient's condition will not be the same as it was a year ago does not seem like a happy solution. The fact that antibiotics are unfortunately not all-powerful and that their power is also decreasing in the long term is also confirmed by the report of the World Health Organization.

PREVENTION

The best prevention is, of course, to strengthen immunity, primarily through a healthy lifestyle. The basis is above all physical and mental well-being, sufficient physical activity, a healthy diet and staying in a healthy environment. For example, the difference between a forest and a normal nursery is really noticeable from the point of view of developing immunity.

CARRIAGE AND INFECTIOUSNESS OF STREPTOCOCCAL ANGINA IN CHILDREN

Carriers of group A streptococci in children in kindergartens and elementary schools can reach 20-30%, but if the finding of streptococci is not a manifestation of an active streptococcal infection or angina, so it is not a dangerous source of streptococcal infection and late consequences.

In addition, in order to detect all possible sources of infection in the collective, it would be necessary to perform a bacteriological examination and simultaneously treat with antibiotics in a single moment not only classmates, but also parents, siblings, relatives, friends and other close people, which would be such a demanding procedure that it is practically impractical and therefore, it is not even recommended by the State Health Institute of the Czech Republic.

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Treatment during pregnancy

Angina in pregnancy is unfortunately very common, although there is no direct connection between pregnancy and streptococcal infection. Of course, a sore throat may not automatically mean angina, but if it is associated with a fever, you should definitely visit your doctor.

The doctor should swab your throat and tell you within two to three days whether it is a streptococcal infection or not.

Until the results are known, we recommend avoiding physical exertion, drinking a lot, eating natural vitamins and applying STREPTOkill. But have its use approved by your doctor, because Streptokill also contains some ingredients that are not recommended to be used during pregnancy or with caution. These are, for example, alcohol and extracts from sage, clove and thyme, although it should be added that these components are present in such small amounts in Streptokill that the use of Streptokill should not be a problem. When you consult with your gynecologist, take Streptokill to show him, because the label will tell you the amount of alcohol, sage and other active substances in Streptokill. If you didn't have the bottle with you, you can find the label here.

If the test result does not show bacteria, then it is likely that the reason for the sore throat is a viral infection. Otherwise, your doctor will probably prescribe antibiotics. There are several types of antibiotics that are prescribed during pregnancy, so you don't have to worry that antibiotics should harm you or the baby any more than if you weren't pregnant. If you decide to take antibiotics, be sure to take them for the entire time and at the intervals determined by your doctor. In any case, you should also remain without physical exertion until you are completely healed, so that the body has maximum energy to cope with the infection.


GROUP A STREPTOCOCCUS VERSUS GROUP B STREPTOCOCCUS

Sometimes when expectant mothers learn that their strep throat is caused by strep, they may search the Internet for information about Group B Streptococcus, which can be dangerous to the fetus. But this is a completely different bacteria than group A streptococcus, which causes angina. Group B streptococcus can occur in the uterus and vagina, from where it can be transmitted to the newborn during childbirth. If doctors detect the presence of Streptococcus B in the birth canal, it is not related to angina in any way, even Group B Streptococcus is treated with antibiotics, but only just before delivery, in order to protect the fetus during delivery.

PREVENTION OF ANGINA IN PREGNANCY

We recommend drinking a lot of water and other fluids so that the body is always sufficiently hydrated, which reduces the risk of infections during pregnancy. Also try to avoid places with an increased risk of infection, such as public transport and other places with a high concentration of people in closed spaces. One of the most important things is to regularly wash your hands, especially when you come from outside.

Last but not least, we recommend a stress-free pregnancy. For example, if you go to a stressful job, then go there with the understanding that you will not let yourself get upset in any way, because now the first priority is a comfortable pregnancy, not work. If you can't do this or if it's simply not possible, consider taking early maternity leave.

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Tonsilectomy

The procedure, which used to be quite common in the last century, however, current findings confirm the importance of the tonsils, so that even more conservative doctors usually resort to it only after a series of antibiotic failures. Those who are less conservative then prefer a non-invasive solution and achieving a normal state of the upper respiratory tract, for example with the help of Streptokill.
If the prescribed treatment fails and angina continues to return, the last resort solution is to remove the tonsils. This procedure is called Tonsillectomy (sometimes also spelled Tonsillectomy).

A tonsillectomy is a procedure in which the tonsils are surgically removed from the throat. Sometimes even partial removal is sufficient. The surgeon removes the tonsils whole if the patient suffers from recurrent angina. The entire operation is performed through the patient's mouth.

WHEN IS A TONSILECTOMY PERFORMED?

- in case of repeated failure of antibiotics
- during short-term respiratory arrest
- when angina repeatedly returns
- for serious problems with loud snoring
- in case of long-term serious problems with swallowing and eating (when the tonsils are enlarged)
- with an abscess on the tonsils


METHODS OF TONSILECTOMY:

- scalpel removal is the most common method and also the most traditional
- LTA (laser removal of tonsils) removal with the help of a laser
- microdebrider removal of tonsils using a rotary device equipped with suction
- the electric cautery burns the tonsils at a high temperature. At the same time, the blood vessels heal and thus less bleeding occurs.

 

POSSIBLE COMPLICATIONS

In most cases, tonsillectomy is successful, but complications are possible, some of which can be life-threatening.
Some of the complications may occur during the procedure. For example:

- the patient's reaction to anesthetics
- infection
- heavy bleeding

Some complications are postoperative:

- sore throat
- bleeding
- infection
- difficulty swallowing
- pain in the ear, jaw or throat

 

The recent case where a seven-year-old girl from Kytlice died in the Děčín Hospital also testifies to the fact that tonsillectomy is not a completely banal procedure and the aforementioned complications are not just hypothetical. She underwent a tonsillectomy, there were no signs of possible serious complications, so she was discharged to home treatment, but after a week the girl's health deteriorated rapidly and despite the efforts of the doctors, she could not be saved.

The tonsillectomy controversy is also evidenced by a study of children's hospitals published in USA Today, which states that out of 140,000 monitored tonsillectomy procedures in children under the age of 18, a full 8% of patients had to visit the hospital again within 30 days after the operation due to complications. The most common complications were bleeding, vomiting, dehydration, pain and infection.

The decision whether to undergo a tonsillectomy is always up to the patient, although it is sometimes difficult to say "no" to a doctor who convincingly claims that the tonsils are in a very bad condition and "have to come out". However, it is necessary to keep in mind that the removal of tonsils is irreversible and therefore it is only the last option. It is therefore a good idea to make sure that all other treatment options have been exhausted before deciding on the procedure.

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Complications and recovery

Sometimes there are complications, such as an abscess on the tonsils, which should be aspirated with a syringe with a needle, cut open with a scalpel or tonsilectomy (tonsillectomy). suppression of infection and inflammation.

Untreated angina can cause a number of complications. Angina can spread to the tonsils or pharynx, and it is also possible to cause inflammation of the kidneys or rheumatic fever, which can appear several weeks after the symptoms of angina have subsided and affect, for example, the heart, joints and skin.

These serious complications are already very rare nowadays, when most sore throats are treated with antibiotics. If the patient wants to make sure that his angina is treated correctly and to minimize the risk of these serious complications after experiencing a streptococcal infection, he can ask the doctor to check the urine and blood after experiencing angina. However, it is necessary to point out that the examination may not always be unambiguous. E.g. blood sedimentation decreases relatively slowly after angina, the values of the so-called ASLO (ASL) antibodies against Streptolysin, a poisonous protein produced by Streptococcus, increase even more slowly, but also decrease.

Normally, our body needs about 2 weeks to recover. However, this time is very individual. After repeated treatment with antibiotics, we must expect that recovery may take longer than a month, on the other hand, after successful treatment of angina without antibiotics, recovery is usually much shorter.

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Prevention

The best prevention is, of course, to strengthen immunity, primarily through a healthy lifestyle.
The basis is above all physical and mental well-being, sufficient physical activity, a healthy diet and staying in a healthy environment. Also stress control and, last but not least, high personal hygiene.
Above all, oral hygiene such as regular tooth brushing, but also the use of interdental brushes and IMMEDIATE disinfection of the tonsils and larynx with every, even slight, sensation of "scratching in the throat". For this purpose, we recommend STREPTOkill, which is also from natural sources and does not develop resistance to it, so it can be used without fear in case of any inappropriate feeling in the throat. We also recommend regular hand washing, which protects not only you, but also your surroundings from transferring bacteria or viruses.

It is also reasonable to limit contact with infected persons who have not yet started their treatment.

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