Treatment of fungal tonsillitis should be carried out in the following sequence:
- In the absence of a pronounced malaise, the causes of the disease are eliminated, if possible, then several days are followed up and the effectiveness of the measures taken is monitored;
- If the disease does not regress in the absence of the alleged causes, or if it immediately leads to a worsening of the patient’s condition, local therapy is prescribed. A few more days (up to a week) treatment is limited only to the use of local means and observation of the results;
- Only if the use of local remedies also does not have an effect, is the systemic administration of antimycotic drugs prescribed.
Immediately, it is not necessary to prescribe intensive therapy with the help of local or systemic antimycotics, since in many cases the fungal tonsillitis passes quickly simply by eliminating its causes. This is especially true in the treatment of fungal tonsillitis in children, for whom cheesy rashes in the mouth are the norm and often do not cause absolutely no concern.
Some parents declare a fungal tonsillitis as soon as they see such a plaque, not only in the child’s language, but also in the throat.
The exception to this rule is made by patients with immunodeficiencies, who are immediately prescribed full therapy. In this situation, the likelihood that pharyngomycosis will pass without treatment is minimal, and immunodeficiency itself is the cause of the disease, and this cause is eliminated very hard and long (if it is eliminable at all).
Elimination of causes of fungal tonsillitis
This is the most important part of the whole therapy, because if there are reasons that have already caused pharyngomycosis, it will continue to develop. It does not make sense to begin treatment of fungal tonsillitis until the factors causing it are identified and eliminated. Almost always, the determination of the causes of the disease and the development of measures to eliminate them should be carried out by a good experienced otorhinolaryngologist and only after the causative agent has been identified and the fungal nature of the disease has been established.
In various cases, to eliminate the causes of fungal angina, you must:
- Stop taking antibiotics;
- Stop taking glucocorticoid hormonal drugs;
- Limit smoking as much as possible and, if possible, stop it;
- Eliminate runny nose and stop breathing with your mouth;
- Maximum limit the consumption of sweet;
- Strictly observe the rules of oral hygiene: brush your teeth at least twice a day, rinse your mouth with water after meals;
- If a fungal tonsillitis has arisen in a child – to ensure that he cries or shouts as little as possible;
- Normalize the microclimate conditions by achieving an increase in the humidity of the air in the room where the patient is located, up to 50-60%;
- Stop a strict diet in violation of the intake of vitamins and proteins;
- If the cause of pharyngomycosis is a weakening of the immunity of another disease – take measures to eliminate the primary disease.
These measures must be taken regardless of the severity and symptomatic picture of fungal tonsillitis. If the disease proceeds without any symptomatic symptoms at all, that is, a rash in the throat is present, but the throat itself does not hurt, there is no fever and malaise, and the patient feels normal, it makes sense for a few days (up to a week) to confine only to measures to eliminate the causes of the disease observe the clinical picture. In many cases, when taking the right measures, the normal balance between the bacterial and fungal microflora in the oral cavity and pharynx is restored, saliva production and treatment of the oral cavity is normalized, and the fungal tonsillitis begins to fade and after 5-8 days passes completely.
Such a white bloom on the tongue in an adult is evidence that he is eating improperly or is keen on drugs.
What to do if the cause of the disease cannot be eliminated?
Such situations really happen. For example, sometimes a patient needs a long-term use of antibiotics or steroid drugs, the rejection of which will lead to the aggravation or complication of a more serious disease. Or cases when a fungal tonsillitis develops due to HIV or artificial immunosuppression. Here, it is necessary to treat fungal tonsillitis immediately after the diagnosis of pharyngomycosis.
HIV virus particles budding from an infected cell.
Local therapy for fungal tonsillitis
The use of local funds is assigned in such cases:
- Severe acute angina with sore throat, fever, the development of generalized symptoms;
- Measures to eliminate the causes of the disease do not work during the week;
- Eliminate the cause of the disease is impossible.
The best means of local treatment are drugs clotrimazole in the form of a solution – Candibene, Candide, Clotrimazole, Kanizon. Such a solution is applied to the lesion sites 4-5 times a day and kept there for 5-6 minutes. They can also gargle, or lubricate the lesion sites with a swab moistened with a solution.
Also effective for topical use:
- Levorin solution;
- Topical solution and lozenges Decamine;
- Terbinafine solutions – Lamisil, Lamisil Uno;
- A solution of natamycin (aka pimafutsin).
These solutions are used to treat affected areas of the pharynx and mouth, or for rinsing. Tablets simply dissolve under the tongue or behind the cheek. However, it is difficult to find them on sale.
Usually the effect of the use of these drugs becomes noticeable 3-5 days after the start of treatment. However, you need to use the funds until the complete disappearance of the symptoms and external manifestations of pharyngomycosis.
It does not make sense to treat fungal tonsillitis with Nystatin or Levorin tablets. If swallowed, their active ingredients are not absorbed in the intestine and cannot act on the infectious agent. There are ways of chewing the tablet and rubbing the resulting gruel into the lesion sites, or pre-grinding the tablets, diluting them with water to form a solution and treating the rash with a similar solution, or simply rinsing the mouth. However, such use of these tools is too time consuming and has no advantages over the use of drugs specifically designed for local use.
A little outdated methods of local treatment of fungal angina is the use of sodium tetraborate (borax) in glycerin, Lugol solution and Miramistin. Also antifungal properties has spray Bioparox, as well as aerosols based on hexatidine – Hexoral and Stopangin. All these agents are antiseptics and, in principle, can to some extent contribute to the destruction of fungal microflora. However, they have a much less pronounced effect than specialized antifungal drugs, and therefore they should not be used for fungal angina. It is much wiser, strictly according to the instructions, to handle the lesion sites with antimycotic solutions.
Use of system tools
Systemic antifungal drugs for fungal sore throat are not recommended for use immediately after the diagnosis of the disease, even if the patient has symptoms of acute inflammation of the throat and the causes of it cannot be eliminated. This is due to the fact that:
- In many cases, the treatment of fungal angina by local means is effective;
- Treatment of fungal sore throat systemic means should be after the identification of the pathogen and its sensitivity to certain antimycotics.
That is, if the disease is properly managed, the doctor prescribes the means of local treatment and at the same time takes a smear from the affected pharynx for culture analysis. If after 4-5 days local treatment does not produce results, he receives the results of the analysis and prescribes a drug against a specific pathogen.
A colony of the fungus Candida albicans from a swab from the pharynx. © Hans. N
In general, systemic antifungal drugs for fungal sore throat are the means of the second line of choice. Their use immediately after diagnosis is indicated for immunodeficiency states, severe forms of diabetes mellitus, chronic recurrent fungal infections of the pharynx. In this case, the doctor cannot prescribe a remedy against a specific pathogen, because he does not know it, and uses drugs of the widest possible action. After receiving the results of culture studies, the purpose of the drug can be adjusted.
As a rule, to cure severe fungal tonsillitis is obtained by the following drugs:
- Fluconazole (Diflucan, Diflazon, Mycomax and others) is considered the gold standard in the treatment of pharyngomycosis. It is used first of all, and only when its inefficiency is replaced by other means. Diflucan suspension is usually treated for fungal tonsillitis in children.
- Itraconazole (drugs Orungal, Irunin, Orunit, Rumikoz), acting on fungi of the genus Candida, and mold fungi. Capsules should be taken immediately after a meal, because in this case the bioavailability of the active substance is increased. The rate for an adult – 100 mg per day;
- Ketoconazole (Nizoral, Mycozoral, Fungistab, Oronazole, and others), mainly used for pharyngeal candidiasis. The rate for an adult – 200 mg per day;
- Terbinafine (Terbinafine, Exifin, Medofloran, Lamisil, and others), as well as itraconazole, effective against mold fungi. Accepted 250 mg once a day;
- Posaconazole in the form of a suspension of 400 mg twice a day for the first 3 days, then 400 mg per day for another 28 days.
When taking all of these funds, blood tests should be given regularly and the condition of the liver and kidneys should be monitored. Systemic antifungal drugs can have a pronounced nephro- and hepatotoxic effects.
The duration of systemic administration of these drugs (except Posaconazole) is usually 14-21 days, but can be increased up to a month and more if necessary. As a rule, as early as 6–8 days after the start of administration, the symptoms begin to subside, and the rash gradually disappears.
In the most severe cases, or when antifungal drugs in pills do not work, intravenous administration of such agents is prescribed:
- Amphotericin B 0.3 mg per kg of body weight per day;
- Caspofungin – 70 mg on the first day, then 50 mg per day for one administration;
- Voriconazole – two doses of 6 mg per kg of body weight per day, then two doses of 4 mg per kg of body weight.
Cases in which intravenous administration of drugs for pharyngomycosis is really necessary are very rare and are characteristic of HIV patients or patients undergoing recovery after transplantation operations with concomitant immunosuppression.
Treatment of fungal tonsillitis in children
The order of treatment of fungal tonsillitis in children is similar to that for adults. The difference here is only in the specifics of the drugs used. For example, from the systemic means, mainly those are used which are produced in the form of suspensions (Diflucan, Mikomax, Flucostat) or oral solution (Orungal, Irunin).
In children, more often than in adults, side effects may occur after taking systemic drugs, and therefore they are prescribed with extreme caution, taking into account the specific health status of the particular child, as well as after conducting additional tests. During the treatment itself, the child’s condition should be carefully monitored.
Difficulties may occur with the use of local treatment of pharyngomycosis in children. With this treatment, it is necessary that the drug is in the mouth for at least 3-4 minutes, and children under 3-4 years old can not always be forced to refrain from swallowing it. The tool usually lubricates the rash before the day and night sleep of the child to ensure the longest presence of the drug in the mouth.
However, it is the local treatment products that are the first-line medicines for children. They are used to treat fungal tonsillitis in the vast majority of cases, and the use of systemic drugs is resorted to only in the most severe cases.
Symptomatic treatment of fungal tonsillitis
If there are too severe symptoms of fungal tonsillitis, in addition to the main treatment, symptomatic treatment can be prescribed:
- In rare cases, when the temperature rises above 39 ° C (or above 38 ° C, but with a general serious condition), antipyretic agents are prescribed: Paracetamol, Nurofen, Nise, Eferalgan;
- In case of severe pain syndrome, the same means are taken. Additionally, gargling with herbs decoction (sage, calendula, chamomile), a simple soda solution, has a slight effect;
- Rinsing with any kind of warm liquid is useful for washing off part of a cheesy coating.
Purposefully to remove plaque itself from the surface of the pharynx or the sky is not worth it. He does not contribute to the progression of the disease, and that part of it, which can be removed without pain and consequences, will be washed away during rinsing.
In most cases, fungal tonsillitis, the need for the use of remedies to eliminate symptoms does not arise.
Almost always, a fungal tonsillitis is successfully and effectively treated at home after consulting, diagnosing and prescribing medicines at a doctor in a hospital. Moreover, her treatment does not require compliance with bed rest, and given the non-communicable nature of the disease, it is not a reason to skip work.
Still, it is better not to take children with pharyngomycosis to kindergarten or school.
Compliance with bed rest in the treatment of fungal tonsillitis is required only in cases where the disease is very difficult, with severe generalized symptoms. On those days when the patient feels severe discomfort, exercise is contraindicated.
When a fungal tonsillitis is necessary to observe the mode of well-being: if you want to lie down and rest, this is exactly what you need to do.
In the room where the patient spends most of the time, it is necessary to maintain normal air temperature (20-22 ° C) and normal humidity (50-60%). It is useful to walk as much as possible and be in the fresh air.
A patient with pharyngomycosis is recommended a diet without a sweet, with flour restrictions, and also with a predominance of soft foods in the form of porridge or mashed potatoes. In the case of significant inflammation of the tonsils, hard vegetables, fruits or bread should be ground before consumption.
For a patient with fungal angina, apples are best prepared in the form of mashed potatoes.
When fungal tonsillitis is necessary to drink as much as possible. After eating, you should brush your teeth and rinse your mouth with water in order to wash off the remaining sugars from the mouth.
Placement of the patient in a hospital is required only in cases of too severe a course of the disease and the need for intravenous administration of drugs. This happens extremely rarely, mainly in the elderly and patients with immunodeficiency states.
- The basis of the treatment of fungal angina is the use of antifungal drugs of local action;
- Systemic treatment of pharyngomycosis is prescribed in the most severe cases and when the use of local remedies does not work;
- The treatment of fungal tonsillitis in children is carried out according to the same scheme as in adults, but in severe cases with the use of precisely children’s means: suspensions and solutions.