Viral or streptococcal
There are fairly reliable guidelines that the doctor uses to assess the likelihood of streptococcus.
- In favor of streptococcus: temperature above 38 °C, plaque on the tonsils, enlarged painful lymph nodes under the jaw, ABSENCE of cough and runny nose, age 3–15 years
- In favor of the virus: runny nose, cough, hoarseness, conjunctivitis, mouth ulcers, diarrhea
Ключевое правило: наличие насморка и кашля делает стрептококковую ангину маловероятной. Гнойные налёты бывают и при вирусной инфекции, в том числе при инфекционном мононуклеозе, поэтому по одному виду горла диагноз не ставится.
Why do you need a test?
The rapid test for group A streptococcus is performed with a tonsil swab and provides results in 5-10 minutes. It solves the main problem: prescribe an antibiotic to those who really need it, and not prescribe it to others.
- Положительный тест — показание к антибиотику для профилактики осложнений.
- Отрицательный тест при типичной картине — назначается посев для подтверждения, особенно у детей.
- При явно вирусной картине с кашлем и насморком тест обычно не нужен.
Infectious mononucleosis stands out separately: pronounced plaques, enlarged lymph nodes, liver and spleen, severe weakness. In this case, antibiotics of the aminopenicillin group are strictly contraindicated - they cause a profuse rash.
Treatment
- For streptococcal sore throat - a full course of antibiotics, usually 10 days. Early cancellation “now that it has become easier” is precisely what leads to complications
- For a viral infection, only symptomatic treatment: painkillers and antipyretics, plenty of warm drinks, rest
- Saline rinses and topical antiseptics relieve pain but do not affect outcome
- Soft, not hot food; for severe pain - cool drinks and ice cream, this is acceptable
- Bed rest during the first days of fever
Смысл антибиотика при стрептококковой ангине не столько в ускорении выздоровления (оно и так наступит), сколько в предотвращении острой ревматической лихорадки, поражающей сердце и суставы. Именно поэтому курс нужно допивать до конца.
Complications
- Peritonsillar abscess - an abscess next to the tonsil: sharp one-sided pain, inability to open the mouth, nasal sound; requires opening
- Retropharyngeal abscess - more common in young children
- Acute rheumatic fever - after 2-4 weeks: pain and swelling of the joints, heart damage
- Poststreptococcal glomerulonephritis - after 1–3 weeks: swelling, dark urine, increased pressure
- Transition to chronic tonsillitis
What doesn't work
- Antibiotics for viral sore throat - do not speed up recovery and have side effects
- Lubricating the tonsils with Lugol's solution injures the mucous membrane, there is no proven benefit
- Compresses and warming the neck during a purulent process
- Rinsing “until you’re blue in the face” instead of painkillers - it’s better to relieve pain with systemic medications
- Taking a prophylactic antibiotic for every sore throat is a direct path to bacterial resistance
