Wed, 05 Feb 2003

Antibiotics for tonsillitis?

Dear Dr. Donya,

My son, who will be eight years old in March, has suffered from tonsillitis since he was small. His doctor prescribes antibiotics every time he gets the symptoms. Usually he is given antibiotics for five days, sometimes even longer. I notice that there's not a single month without antibiotics. His doctor does not agree to remove his tonsils, as suggested by the ear, nose and throat specialist, since my son is prone to allergies.

He said the operation would not guarantee that he won't have infections and it is not the only way out. An operation is needed when the tonsils cause an obstruction of the airway.

My son has never experienced that.

The doctor said that antibiotics would not harm him even though my son would have to take them for a long time. He mentioned that there was a similar case of a child who had to take antibiotics until the age of 18.

I tried to get the opinion of two other doctors (pediatricians). Two of the three doctors do not agree with the idea of an operation.

I have read and heard a lot that the prolonged use of antibiotics is not good for the body. All medicines have side effects. I'm afraid that the antibiotics may damage his kidneys.

I'd like to have your opinion on this matter. Thank you.

-- Wahab

--Dear Wahab,

I agree with your doctor. Surgery was once the standard treatment for tonsillitis but today doctors are far more reluctant to remove tonsils. One reason is because tonsillitis can often be treated effectively with home care or antibiotics, which reduce the risk of possible complications.

What are tonsils? Tonsils are a pair of specialized lymph nodes, located on either side of your throat, just behind and above the tongue. They help filter out harmful bacteria and viruses that could cause more serious infections. They're part of your body's immune system that helps protect you from microorganisms that may cause infection. They do this by storing white blood cells that engulf bacteria and viruses as they enter through your nose and mouth.

If treated with antibiotics, the symptoms of bacterial tonsillitis should disappear in just a few days. Surgery is generally considered only if tonsillitis affects your child's breathing or is severe enough that bleeding occurs from the tonsils, or if the condition occurs unusually often. --Dr. Donya

Dear Dr. Donya,

I was very happy to read your article about tuberculosis in The Jakarta Post. I was wondering if everyone in Indonesia has had the BCG vaccination.

My husband, our two sons and I have lived in Indonesia for nearly eight years and are intending to stay here for some more time.

My son, aged three and a half, has had the BCG. Is that enough? Or do I also have to have him vaccinated for Mantoux? My second son is four-and-a-half-months old. He will have the BCG in a month's time after his DKTP + Hib III (next week).

For my husband and I, do we have to do the BCG again? I'd like to know if a person of over 30 years of age has to have the BCG in Indonesia? I'd like to make sure that my staff are healthy.

Thank you very much and my best regards. --Djamila

Dear Djamila,

Thank you for the questions and sorry if my unclear terminology has confused you because BCG is the term for the vaccination but Mantoux is the term for the tuberculin skin test.

* Your first son doesn't need the Mantoux test.

* Your second son should be vaccinated. The BCG vaccine can be administered at the same time as DPT, Hib or after DTP and Hib one month later as you mention.

* For adults, you and your staff -- exposure to mycobacterium tuberculosis may lead to infection, but most infections do not lead to disease. The risk of developing the disease following infection is generally 5 percent to 10 percent during a lifetime, but may be increased by various factors, such as immunosuppression (e.g. advanced HIV infection). If you want to make sure about it, you can talk to doctors and ask for a PPD skin test. WHO still recommend the tests for screening including CXR (chest X-ray).

Best regards, --Dr. Donya