Why Does Tonsillitis Persist Without Improvement?

Everyone knows that tonsillitis is an infectious disease causing inflammation of the tonsils. Yet, despite treatment, symptoms sometimes persist. Why does tonsillitis fail to resolve?

Why Does Tonsillitis Persist?

Inappropriate or non-targeted medication may lead to persistent tonsillitis. Acute tonsillitis—particularly purulent tonsillitis—is most commonly caused by infection with beta-hemolytic streptococcus (Group A Streptococcus). However, viral infections and “excess heat” (a traditional Chinese medicine concept referring to inflammatory conditions) cannot be ruled out. Therefore, blood tests should first be performed, followed by targeted therapy based on test results. For bacterial infections, penicillin or cephalosporin antibiotics are typically prescribed. If the patient is allergic to penicillin or cephalosporins, macrolides such as erythromycin may be used; however, oral administration is generally less effective, and intravenous infusion is preferred.

If the cause is viral, antiviral therapy or treatments aimed at clearing heat and detoxifying may be administered, especially in infants. The duration of drug therapy may be insufficient—typically, antibiotics should be administered for at least one week. Medication may be discontinued only after body temperature has normalized for 2–3 additional days. When necessary, blood cultures should be performed to identify the causative pathogen and guide selection of sensitive antimicrobial agents—or combination therapy.

Patients should drink plenty of water and pay close attention to diet—avoiding spicy or stimulating foods such as seafood. Dietary care is especially important during childhood tonsillitis. In some cases, intravenous immunoglobulin may be administered to enhance the child’s immune function. Surgical intervention (tonsillectomy) should only be considered if recurrent or frequent episodes of tonsillitis persist, typically around ages 8–10. We hope this article has been helpful. Wishing you a joyful life and good health!