Red Throat

Most common symptom which make parents rush to hospitals or demand an emergency appointment. Patients who complaint of sore throat often have other symptoms like fever, cough or ear pain but for some reason beyond my comprehension, people only mention “Sore Throat” and assume they have “Tonsillitis” that require “Antibiotics”.

Even after spending 15-20 minutes explaining to patients all about sore throat, tonsilitis and educate them about “Salt Water Gargles”, I was surprised to hear this patient had visited the A&E in the local hospital or Walk-in-clinic, OOH Service or seen another GP in the surgery or consulted a Gp (Private) to get the Antibiotic he or she expected me to have prescribed. I had to ask myself this simple question, Where have I gone wrong?

What makes these people pop pills and not try and see if they get better on their own? Why are they so keen on taking this antibiotics?

I went through the clinical notes (from childhood) of patients who consulted me with what I diagnosed as “Viral Tonsillitis“. These are the children who were taken by their parents to consult their GP very often and received antibiotics for sore throat, rash, cough, ear pain and even tummy pain. There was no logic nor any set pattern to this habit of prescribing antibiotics. Patients in UK were happy to consume this antibiotcs as they were not expected to pay. This routine visits and regular prescription of antibiotics claiming to save lives has conditioned and made these people “Dependent” on the doctors.

Some doctors like me will never be able to help bring in changes but will certainly be encountering resistance. Even the members of medical profession have challenged my approach and do not accept it is in the interest of medical profession we must change.

I cannot only blame patients but must also criticise members of my profession namely “Doctors”. Some doctors are also conditioned to believe they must treat red throat, red ears and coughing green phlegm. Why do they believe and what makes them give antibiotics when it is not indicated?

I tested this hypothesis in my clinic and see what will be the outcome and how patients will react. The finding of my observation was fascinating and I know it is possible to brain was any patients who trust you and believe you know better than them.

Virus infections, screaming loud (crying babies), excessive coughing, and any throat irritation (using lozenges) can make the throat go red. Redness in your throat is due to excess blood circulation and can be due to irritation. If you have dry throat in the morning and have been snoring all night because your nostrils were blocked at night, please check out your throat, it is likely to be red and sore.

Diagnosis of Streptococcus throat infection can only be made after blood test (ASOT) or throat swab cultures. Spots on tonsils does not mean to say the infection is bacterial. infectious mononucleosis (glandular fever) and other viral infections produces white patches on tonsils.

Streptococcal infection (Bacteria) produce mild increase in temperature and the patients is often toxic (facial flushing, feeling faint and tired). They also feel hot and cold (chills & rigours) because the body thermostat control (hypothalamus) will increase blood circulation in the skin to help reduce body temperature and so produce sweating) tonsils and neck glands are painful and large (not due to infection but because the white blood cells are fighting the invading bacteria). Most patients with bacterial infections die due to shock and not due to very high temperature

Streptococcus throat infection was a major problem before penicillin was invented in 1940s. The doctors relayed on clinical assessment to diagnose because toxins, meningitis, or rheumatic fevers could result in death. As a child, my doctors used iodine swab on my throat to killed germs living on the tonsils. Since antibiotic became available, the problem of long term complications was not a major threat.

This bacteria can produce what was known as “Rheumatic fever” due to the toxins resulting in damaged heart valve (mitral stenosis) and also meningitis, nephritis and arthritis. Unfortunately the bacteria will release toxins before you recognise the symptoms. Giving antibiotic to patients does not prevent the damage occurring in all, because some have developed signs later in life and are on long term antibiotic prophylaxis to prevent relapse.

Unfortunately due to this fear and litigations and huge compensation payments awarded by courts, doctors started prescribing antibiotics for every patients presenting with sore throat. If a doctor refuses to prescribe antibiotics, the patients will seek help from another doctor and start taking antibiotics. The dose prescribed is often low (penicillin 250 mg) and the patients do not complete the course. This abuse of antibiotic has now resulted in resistant strains and is likely to threaten our existence.

In future, please think twice before you waste your money and abuse antibiotics. We must not push our luck any further. I think it’s already too late even if God appears on this earth to save this planet, He will be confused on how to fight this bacteria.

RED THROAT

The common term used as diagnosis of acute pain in the throat is “Tonsillitis”. Diagnosis and management of this illness depends on the duration of the symptom and associated symptoms.  Some doctors and nurses often diagnose “SORE THROAT” as “Tonsillitis” and prescribe antibiotics. You must be aware “Red Tonsils” does not always mean to say you are suffering from a bacterial infection that require antibiotics. Tonsillitis is more often caused by viral infection and not bacterial. Fever is often very high but the bacterial infection is often associated with mild to moderate fever. Both these infections are and associated with malaise (tiredness, weakness) and so very difficult to clinically differentiate viral from bacterial throat infections.

Recurrent sore throat occur in people who snore at night, has allergic irritation, immune-compromised or on medication which may cause suppress blood production and is called “Agranulocytosis”)

Doctors often examine your throat to assess inflammation (redness) of pharynx; look for exudates (secretions) on the tonsils. This is often described as “WHITE OR RED SPOTS ON THROAT WITH SWOLLEN PAINFUL GLANDS IN THE NECK”. This may be diagnosed as acute tonsillitis but to be specific you need to have other associated symptoms like fever, malaise, may or may not be with rash.

Please note the throat can look red if the child has been crying out load or after sucking lozenges (irritation of your throat) and so is not a good indicator of throat infection and labeled as “Tonsillitis”. Often the doctors or nurses examine your ears and claim to diagnose this as “URTI” (Upper Respiratory Tract Infection. It is not clinically possible to differentiate bacterial from viral infections based on this sign.

If you have barking cough or stridor (noisy breathing) asking the patient to yawn or pant may improve the view. Doctors must not use a tongue depressor – beware of epiglottitis  “GRUNTY NOISE OR STRIDOR”. This is a serious infection caused by H Influenza (virus) that will need hospital treatment. Children often wake up and look very anxious with saliva drooling from their mouth. You must be in hospital (Call 999)

Swollen glands in the neck (cervical lymphadenopathy) are often noticed to be hot and painful to touch indicates bacterial infection.

Typical history of “GLANDULAR FEVER” is “WHITE SPOTS IN THROAT WITH SWOLLEN PAINLESS GLANDS IN THE NECK”. This is common in teenagers and the spread is from mouth to mouth and so called “Kissing Disease”. Common in teenagers and is often associated with pain in ears. Patients get recurrent sore throat, muscle weakness and tired all the time. This is one throat problem often not diagnosed and so patients are often prescribed antibiotics though it is not necessary. If you have regular symptoms or the symptoms persists for more than a week, you must get blood test to rule out glandular fever and agranulocytosis

Please ask your doctor to perform blood test and do not abuse antibiotcs. You must be aware that Amoxicillin (antibiotic) can produce rash all over your body and so must not be taken.

If there are few glands, which are matted – linked to one another, you must consult a doctor. This will require blood test, chest X Ray and may be a biopsy to find out what is wrong with you.

If streptococcus often produce macular rash (small red patches, not raised) and will require antibiotics

Antibiotics are of marginal benefit in most cases, and at best will only shorten the illness by 24 hours. Against this must be weighed the cost to the patient, risk of side effects, colonizing antibiotic resistant bacteria.

Patients on large dose of steroid, cancer treatment, blood disorders, have poor immunity, or if severe malaise or macular rash present may need large dose of antibiotics and so must consult a doctor as emergency.

Often patients with sore throat get better but wrongly diagnosed or when treated using low dose antibiotics or patient not completed the recommended duration, the throat develops and abscess. This is termed QUINCY. Typical history is “UNABLE TO SWOLLOW” or “FEEL LUMP IN THE THROAT”. This complication must be treated in the hospital.

MANAGEMENT

It is difficult for doctors not to prescribe antibiotics no matter what we know and how strong we are to say “NO TO ANTIBIOTICS” ´Easier said than done. It is left to patients to decide because it is their life and their body that are colonised with antibiotic resistant bacteria. Penicillin is a very narrow spectrum antibiotic (works only on one bacteria), so doctors will prescribe but there is no guarantee that this bacteria is not resistant.

Symptomatic treatment for most patients (ibuprofen or over-the-counter paracetamol, benzydamine spray). I think we must stick to salt water gargles because this can still kill bacteria that are living in the mouth and throat.

I often prescribed antibiotic the patient was feeling hot and cold, has a lump in the throat, developed a rash, had red tongue or painful glands in one side of the neck.

Adults and children aged 10 years and over, often prescribed Penicillin V for 7-10 days (Please check the dose based on weight, if you take lower dose, the bacteria in your body is likely to develop resistant.

Children under 10 years, we recommend amoxicillin suspension for 7 days. This drug likely to cause side-effects than Penicillin V. Young children find the taste of Penicillin V suspension unpleasant and often refuse to take it resulting in inadequate dose.

Patients who are known to be Allergic to penicillin are often prescribed, Erythromycin or Clarithrormycin. Erythromycin can produce numerous side effects and may not be tolerated

CONSULT DOCTOR IF

The spiking high temperature change to feeling hot and cold or you have mild-moderate fever.

The child very sick, drooling, cannot swallow, do not examine throat

Large swelling around one tonsil (possible quinsy, may need surgery). Patients often treated with inadequate dose or wrong antibiotics will develop this complication.

On drugs that can cause agranulocylosis. If this is suspected, take immediate advice from a doctor regarding stopping the medication

REFERENCE

  1. Del Mar C, Glasziou P and Spinks AB (2004) Antibiotics for the symptoms and complications of sore throat (Cochrane Review). The Cochranc Library, Issue 2, 2004. Update Software, Oxford.
  2. Little P Williamson I, Warner C e( al. (1997) Open randomised trial of prescribing strategies in managing sore throat. BMJ 314: 722-7.

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