Sore throat and bleeding nose
by Milena, Oct 26, 2001
My boyfriend suffers from a very sore throat,tonsils extremely bulged,blocking the throat.He was prescribed antibiotics -Peniciline(as he was said to have tonsilitis)and finished one course of it-500mg 4 times a day.The pain was relieved but once he stopped the antibiotics the tonsils returned to their previous bulged state.Now it is starting all over again.

Another thing I am woried about is his nose bleeding without any obvious reason.We thought that his capilars in the  nose might be too fragile and when the blood pressure goes a bit up he bleeds.However,it does not seem normal to me this to happen so often.Almost every day,at times even several times a day.

What would you suggest in this case?
by Forum-M.D.-DT, Oct 26, 2001
The symptoms you are describing sound like there is an infection that has not been fully treated. The symptoms of recurring sore throat and nosebleeds make me think he has a persistent sinus infection. If the sinuses remain infected, they will continue to drain down the back of the throat and cause a sore throat, and may irritate the tonsils as well. The penicillin appears to have helped but as is the case with sinus infections, many times either you have bacteria which are "resistant" to the antibioitic OR you have a course of antibiotic therapy which is not given for long enough.
Here is how I would approach this problem.
1) Start the patient on a "broad spectum" antibiotic such as AUGMENTIN ("Sanford guide to antimicrobial therapy" lists this as the preferred medication to treat this type of sinus infection) You may need to give this for up to 3 weeks.
2) Begin to aggressively try to "clear" the sinuses through the use of a combination antihistamine/decongestant such as Claritin-D, Allegra-D, or Zyrtec-D.
3) Apply vaseline to the nasal passages to keep them moist and prevent dryness/cracking of the nasal passages which can increase the occurrence of nosebleeds.
4) Use a nasal steroid spray such as Nasacort, which has the component of "glycerin" which will help to keep the nasal passages somewhat moist, while also helping to clear the sinuses.

You may want to share this information with his doctor to see if he/she concurs. This is how I would approach a problem such as what you describe here.
I hope this is helpful, and thank you for visiting the Family Practice forum.
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