Angina, streptococcal angina J03.0

Inflammation, redness and swelling of the throat, especially of the tonsils.

Most commonly Streptococcus pyogenes; rarely Streptococcus pneumoniae or Staphylococcus aureus.

Severe pain, especially when swallowing, foetor ex ore, fever, headache, swelling of the mandibular angle lymph nodes. Distinguish:

• A. catarrhalis: redness and swelling of the palatine tonsils.
• A. lacunaris (tonsillitis, angina follicularis): Formation of purulent stipples and patches in the crypts of the tonsils.
• A. lingualis (tongue base angina): Serous to purulent inflammation of the tongue base tonsils.
• A. retronasalis: inflammation of the pharyngeal tonsil, swelling of the nuchal lymph nodes.
• Lateral trangangina: inflammation of the lateral cords.

Plaut-Vincenti angina, agranulocytic angina, specific angina, angina associated with tuberculosis, diphtheritic angina, herpangina, infectious mononucleosis, candidiasis, tonsillar carcinoma.

Peritonsillar abscess, tonsillogenic sepsis, post-streptococcal complications (rheumatic fever, post-streptococcal glomerulonephritis).

Bed rest, always detect streptococci in children first (throat swab).

Antiseptic mouth rinses e.g. chlorhexidine gargle solution ( R045, chlorhexidine digluconate solution), tormentil astringent R255, dexpanthenol solution (Bepanthen Roche solution, R066 ).

• Penicillin V: Adults—600,000 IU 3 times daily or 1 million IU 2 times daily, taken by mouth for 10 days. Children: 50,000–100,000 IU/kg body weight per day, taken by mouth.
• Alternatively: In case of penicillin allergy, erythromycin (e.g., Paediathrocin) 250–500 mg 3–4 times daily by mouth or intravenously; children: 20–50 mg/kg body weight per day divided into 2–4 doses; clarithromycin (e.g., Klacid) 250–500 mg twice daily by mouth; children: 15 mg/kg body weight per day divided into 2 doses by mouth
• Alternatively, cephalosporins such as cefpodoxime (Orelox). In case of recurrence, cephalosporin or clindamycin (e.g., Sobelin) 300 mg orally 3–4 times daily; children 8–25 mg/kg body weight per day orally, divided into 4 doses.
• Analgesics such as acetaminophen ( e.g., ben-u-ron suppositories) for children or acetylsalicylic acid (e.g., ASS) for adults.