Acute-phase reactants in children with recurrent tonsillitis treated by tonsillectomy versus long-acting penicillin
Azza Mohamed1, Mohamed El Tabbakh2, Alaa Zeitoun3, Diaa El Hennawi2
1 Department of Otorhinolaryngology, Ismailia General Hospital, Egypt
2 Department of Otorhinolaryngology, FOMSCU, Ismailia, Egypt
3 Department of Pediatrics, FOMSCU, Ismailia, Egypt
Mohamed El Tabbakh
Department of Otolaryngology, Head and Neck Surgery, Seuz Canal University, Faculty of Medicine, Ismailia
Source of Support: None, Conflict of Interest: None
Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and the otolaryngology surgeon have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery? This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT) and erythrocyte sedimentation rate (ESR).
Patients and methods
A total of 200 patients aged 4–15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, who were attending the Ismailia General Hospital were included in this study; they were divided to two groups comprising 100 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated; ESR and ASOT levels were recorded for all patients before management, after 3 months, and after 6 months.
The mean ESR readings before management, after 3 months, and after 6 months for the first group treated by tonsillectomy were 45.28, 22.36, and 7.4 ml/h, respectively (P-value<0.0021); for the second group treated with penicillin, they were 45.39, 14.98, and 6.48 ml/h, respectively (P-value<0.020). The mean ASOT readings for the tonsillectomy group were 518.29, 253.28, and 117.13 IU/ml, respectively (P-value<0.004), whereas for the penicillin group, they were 526.70, 413.39, and 262.98 IU/ml, respectively (P-value<0.072).
This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up, and in patients, have contraindications for surgery such as bleeding diathesis.