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Having puss at the back of the throat. Diagnosed tonsillitis. Prescribed amoxic. Have swollen lymph nodes in neck. On Zpack. What could this be?

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General & Family Physician
Practicing since : 2009
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I had a little puss on the back of my throat about three weeks ago and it was diagnosed as tonsillitis and a round of amoxic. was prescribed. My tonsils never got swollen or got worse. I had a tight feeling at the bottom of my throat that got worse and moved up; I now have a pus or yellow/white coating on the back of my tongue , swollen lymph nodes in neck and chest, the feeling of something in my lower throat and like i need to burp. I got a shot of penicillin 2 weeks ago and nothing got better. I'm on a zpack not and it is not helping. what if anything could I do and what the heck is this??

Thank you
Posted Sat, 26 Oct 2013 in Ear, Nose and Throat Problems
Answered by Dr. Luchuo Engelbert Bain 51 minutes later
Brief Answer:
Complete Peni V regimen, 10days and throat swab

Detailed Answer:
Hi and thanks for the query,

I understand it can be disturbing taking drugs without any improvement. However, I think the option of the penicillin as choice of drug was reasonable. However, persistence of symptoms could imply either resistance to the causative bacteria, or inadequate treatment.

To my patients, I suggest a throat sample and culture. This is important in order to diagnose the exact bacterium causing the infection, and also to identify the antibiotic that shall effectively treat it. A ten day regimen of penicillin as was previously prescribed to you is usually sufficient. In case the infection and swollen lymph nodes are persisting, it might be necessary for your family physician to do a reevaluation. This is to exclude a possibility of a tonsillar abscess, a common complication of tonsillitis.

Knowing if you have this infection regularly is important,. In case its very regular, the opinion of an ENt specialist might be needed. This is so because, recurrent infections could cause cardiac and joint complications called Rheumatic fever.

I suggest a consultation with your family physician, a throat swab and culture. He could put you on a complete penicillin V regimen as results are being awaited. Thanks and kind regards as I wish you the best of health. Feel free asking follow up questions in case of need.

Bain LE, MD
Above answer was peer-reviewed by
Follow-up: Having puss at the back of the throat. Diagnosed tonsillitis. Prescribed amoxic. Have swollen lymph nodes in neck. On Zpack. What could this be? 36 hours later
I was checked for an abscess and they found nothing. I work at a chicken farm with a lot of droppings around. I have a white film on my tongue, painful throat, and pain in chest when I inhale. Could this be histoplasmosis? If so will a zpac help. I am tired of being sick and my doc is not very good with working fast. I am getting a blood test Monday morning to check for histoplasmosis antibodies but I have never had a fever with this?? It is confusing and scary.

Thank you
Answered by Dr. Luchuo Engelbert Bain 17 hours later
Brief Answer:
No worries yet, much can be changed for good.

Detailed Answer:
Hi and thanks for the query,

It is true that histoplasmosis could affect the lungs and cause chest pain and other respiratory difficulties. However, it is better to exclude and treat common diseases that produce such manifestations. Histoplasmosis is not very common. It is a possibility. Doing a blood test to check for histoplasmosis is good, but it must be borne in mind that the test is neither specific nor sensitive. This means that positive results or negative results might not truely depict the absence or presence of the disease. Other clinical based based on a thorough physical exam and chest X XXXXXXX results are still very important.

I still very much suggest a proper throat exam for common infectious agents like bacteria (streptococci), get a culture and sensitivity tests done first. Broad spectrum recommended antibiotics given properly (Penicillin V for 10days) as results of culture results are awaited. IN case your ENT specialist fails to identify a germ, or failure of treatment, other organisms like Treponema P that causes Syphillis that could affect the throat in some circumstances and Histoplasmosis could be considered.

Thanks and kind regards. Feel free asking any specific questions. I would be glad to answer.

Bain LE, MD
Above answer was peer-reviewed by
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