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Rapid strep test negative, throat sore, tiny pus pockets on tonsil, on and off fever with chills, on azithromycin. Best medicine?

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ENT Specialist
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I went to see a doctor yesterday because I thought I may have strep throat. The rapid strep test came back negative. However, My tonsils ans throat are extremely sore, it is very hard to swallow, and there are tiny pus pockets on my tonsils. I also have been running a fever off and on, with a headache, and body chills. I feel very weak. The doctor put me on azithromicin, but honestly I feel worse today than I did yesterday. Any suggestions on what to do or what could be wrong?
Posted Thu, 3 May 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for your query.

1. You seem to have developed Acute Follicular Tonsillitis. A large number of viruses and bacteria may cause this. An antibiotic may not be of much help in an early viral tonsillopharyngitis. Sometimes the antibiotics only help prevent secondary bacterial infection. Ideally a combination of amoxicillin (beta lactam / penicillin group) and clavulanic acid such as Augmentin 625 mg twice a day for a week would be the antibiotic of choice. However since you have penicillin and sulfa drug allergy, Azithromycin (macrolide group) has been prescribed. This will not be as effective. Hence you will also require supportive treatment with a medicated mouth washe such as Betadine, anti-fever, anti-inflammation and anti-allergic medication. Discuss this with your physician.

2. In addition to your symptoms mentioned above, do you have any pain referred to the ear or trismus (unable to open the mouth / jaw fully)? Do you have any painful enlarged lymph nodes in the neck?

3. Fever with chills may be a sign of many pus pockets , some of which may be developing behind the tonsil. Pus is acidic and hence most antibiotics do not act well in an acidic medium. You may require additional antibiotic groups such as an metronidazole (imidazole group).

4. Usually antibiotics require 24 to 48 hours to be effective. If you are feeling worse even after 48 hours, you may request another throat swab and plan a change of antibiotic. If you do not have a strong allergy to penicillin (beta-lactam) group of antibiotics, a cephalosporin group (also a beta-lactam group) may be tried out.

5. The tonsils have a major role in signalling the rest of the body against infection and allergy. This causes a massive release of chemical messengers into the blood stream and makes one feel miserable. Hence supportive medication mentioned above is required.

6. In extremely severe cases, or those with complications, I admit patients for intravenous antibiotics and indoor care. The possibility of Infectious Mononeucleosis (viral) must always be kept in mind. In some severe cases, steroids given under antibiotic cover may also help. Your diet should be totally bland, mashed if possible and no cold or sour food should be taken.

Hope I have answered your query. If you have any follow up queries, I will be available to answer them.

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