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Membranous tonsillitis: Aetiology, prevalence and prescribing patterns in patients with upper respiratory tract
1Department of Paediatric Emergency Medicine, Erciyes University Faculty of Medicine, Kayseri, Turkey.
Abstract:
Background Membranous tonsillitis is one of the most common forms of acute tonsillitis in childhood. Although many different microorganisms may cause this disease, clinicians generally consider bacterial agents as a possible cause and prescribe a penicillin-group of antibiotic. This study aimed to determine the aetiology of membranous tonsillitis and prescribing errors. In addition, we investigated the effectiveness of epidemiological, clinical and laboratory parameters and their role in guiding treatment. Methods We did this retrospective study at the paediatric emergency department of a tertiary referral hospital including 423 outpatient children aged 0 to 18 years diagnosed with membranous tonsillitis. Results Group A beta-haemolytic streptococcus was found in 132 (31.2%) patients, Epstein-Barr virus (EBV) in 103 (24.3%), and other viral aetiologies in 188 (44.4%). The prescription rate of antibiotics in the EBV-positive group was 27%, and Downey cells were seen at a rate of 98% in this group. Only 7% of patients with a positive throat culture were started on appropriate antibiotics. Conclusion EBV and group A beta-haemolytic streptococcus were the most common causes of membranous tonsillitis. Throat culture and peripheral blood smears are the most useful tests for paediatric emergency clinicians; these are fast and can help ensure correct diagnosis and guide treatment in almost all patients.
Insights
Membranous tonsillitis in children is commonly caused by Epstein-Barr virus (EBV) or Group A Streptococcus. Throat cultures and blood smears aid accurate diagnosis and appropriate treatment, reducing unnecessary antibiotic prescriptions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Membranous tonsillitis is a frequent childhood illness.
- Bacterial infections are often suspected, leading to antibiotic use.
- Accurate etiological diagnosis is crucial for effective treatment.
Purpose of the Study:
- Determine the causes of membranous tonsillitis in children.
- Identify prescribing errors in antibiotic use.
- Evaluate diagnostic parameters for guiding treatment decisions.
Main Methods:
- Retrospective analysis of 423 pediatric patients with membranous tonsillitis.
- Data collected from a tertiary referral hospital's pediatric emergency department.
- Inclusion of epidemiological, clinical, and laboratory findings.
Main Results:
- Group A Streptococcus (31.2%) and Epstein-Barr virus (EBV) (24.3%) were primary causes.
- Viral etiologies accounted for 44.4% of cases.
- Antibiotics were prescribed in 27% of EBV cases; only 7% received appropriate antibiotics based on throat cultures.
Conclusions:
- EBV and Group A Streptococcus are leading causes of pediatric membranous tonsillitis.
- Throat cultures and peripheral blood smears are valuable diagnostic tools.
- These tests facilitate accurate diagnosis and appropriate treatment, optimizing antibiotic stewardship.
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