Adenoiditis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]

The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include amoxicillin – clavulanic acid or a cephalosporin.

• There are no proven evidence of medical therapy effectiveness in recurrent or chronic adenoiditis cases.^[1]
• Systemic oral antibiotics can be used if the suspected organism is a bacteria and should be prescribed for a long-term (i.e. 6 wk) for lymphoid tissue infection.
• The most appropriate antibiotics are amoxicillin – clavulanic acid or a cephalosporin.
• Cephalosporins and macrolides are considered good alternatives to penicillin in the acute setting.^[2]
• A macrolide such as erythromycin is indicated for patients allergic to penicillin.
• Although antibiotic therapy can treat acute adenoiditis, it usually fails to eradicate the bacteria in chronic or recurrent adenoiditis.^[3]

• Nowadays with the current trend of resistant bacteria, the use of prophylactic or long-term antibiotics has been decreased.^[4]

• Topical therapy:
  • Topical nasal steroids in children can be used to treat adenoid hypertrophy.
  • Topical nasal steroids can lead to adenoid shrinkage slightly (ie, up to 10%), which may help relieve some nasal obstruction symptoms. However, it is not a permanent therapy and all symptoms may raise again after discontinuation of topical nasal steroid.
  • A combination trial of topical nasal steroid spray and saline spray may be considered for effective control of symptoms in children.
• In cases of viral adenoiditis, treatment with analgesics or antipyretics is often sufficient.^[5]