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Took Erythromycin and penicillin for tonsillitis. Felling cold. Rheumatic fever?

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Practicing since : 1984
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18 year old male tonsilitus given penicillin on Monday was still very ill on Wednesday doctor said if no improvement in 24 hours start taking new drug Erythromycin he showed slight improvement in him self next day so stuck with penicilin, however the tonsils are still very swollen with the white blisters on them and he is still unwell although starting to feel better. My worry is should I switch to the other drug now Erythromycin as maybe his was resistant to penicilin and he is just fighting it on his own, I don't want complications like rheumatic fever if we haven't killed the bacteria. Should his tonsils look better by now they have reduced swelling slightly but still very sore and white blisters still present. Should they look better than this please advise, he is starting to feel better but still gets very hot or cold and nurofen and parecetomal are working for this, he is getting his appetite back also. My worry to switching originally was that erythromycin could make him feel sick and I thought he was poorly enough so give it another day I did not know then the risk of rheumatic fever .
Posted Thu, 28 Mar 2013 in Ear, Nose and Throat Problems
Answered by Dr. A.K. Srivastava 3 hours later

Thanks for your query.

I have gone through your query regarding effect of antibiotic penicillin in the treatment of tonsillitis in your child; you are in confusion on the comparative effect of penicillin Vs erythromycin to enhance the recovery phase and to protect your child from complication like Rheumatic heart disease.

In this connection, I want to tell you that effect of antibiotic on any infection depends on sensitivity of the infective organism (bacteria) for that particular antibiotic. This we can find out by culture and sensitivity test of throat swab. Here, I would like to tell you the overall recovery from infection depends on these factors-

(1)     Antibiotic- This should be chosen according to culture and sensitivity report.

(2)     Systemic diseases- This indicates interference of some systemic disease like DIABETES. So if anyone is having high blood sugar level will show poor effect of antibiotic as compare to normal if his diabetes is not properly managed.

(3)     Nutritional status of patient- If patient is having poor nutritional status and is suffering from hypoproteinemia, vitamin deficiency and anemia will have poor response to treatment.

In your child since he is responding to penicillin but if response does not appear up to the XXXXXXX than culture and sensitivity of throat swab should be done to find out the correct antibiotic, this will be the right direction to follow. In the same time he should also be investigated for – Blood sugar, serum proteins, ASO titre (Antistreptolysin) and X-Ray chest to rule out other factor which may delay the recovery process.

I hope this will clear your doubt.

With Regards,
Above answer was peer-reviewed by
Follow-up: Took Erythromycin and penicillin for tonsillitis. Felling cold. Rheumatic fever? 11 hours later
My query is that on day 4 and then day 5 he is recovering by day 5 his tonsils have started to shrink in size they are still enlarged but noticeably smaller he is feeling better although still unwell when meds run out his appetite returned day 4 and is getting better day 5. My concern is whether he is fighting the strep throat on his own or penicilin did have a positive effect should the tonsils and him have felt better before day 5. Do we still need to use a different antibiotic to rule out rheumatic fever or is it normal to take 5 days to see positive effects. It's the after effects of the strep throat I am worried about did the penicilin work is it working we were told 2 days he definitely did not feel better after 2 days his throat swab will not be back til mon/tues and I don't want to miss window to treat effectively with an antibiotic, rheumatic fever worries is the reason I wrote to you.
Answered by Dr. A.K. Srivastava 38 minutes later

Thanks for writing back.

It would be hard to predict whether your son is recovering by the effect of penicillin or by his own body immunity on clinical grounds. Awaited culture and sensitivity report will be able to answer this query. If the report indicates penicillin resistance then your son has likely recovered on his own. On the other had if penicillin is seen sensitive to the infecting organism then credit for recovery has to be given to the antibiotic.

I understand your worry about complications; since your son is recovering well he is less likely to develop complications. You can discuss with your treating doctor about addition of other antibiotic along with penicillin for additional benefits. Alternatively you can wait for culture and sensitivity report and decide accordingly.

Hope I have answered your query. Let me know if you have any other enquiries.

With Regards.
Above answer was peer-reviewed by
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