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Tonsilectomy versus longterm antibiotic therapy

Dear expert team,
our daughter, 8 years, CF, suffers for one year from repeated infections with streptococci. She is 118cm heigh and weighs 18,4 kg. Each infection is accompanied by high fever and reduced health status. Due to the pain in the throat, she deteriorates quickly and does not drink and eat anymore, so that it has to be treated in hospital several times. In the throat swab always strepotococci can be found, that are immediately treated with antibiotics. ...with good success concering her status. According to the CF center, we give the antibiotics always for 20 days. After the 20 days, we can just wait until it starts again.
After it had been like this for 4-5 times, our center recommended an antibiotic cure with cefuroxim for 3 months, which we did. In this time, we had no episodes of tonsillitis.
Now, just 3 days after finishing, it starts again; high fever, pain in the throat, reduced status and streptococci. We directly started with amoxicillin plus clavulanic acid, and only after 1.5 days she is free of symptoms again.
Now to our question: should the tonsills be removed, like the ENT specialist is recommending it or should rather a longterm antibiotic therapy be done? What about the operation for tonsillectomy and anaesthesia and CF? We are afraid, that the infections turn to go down to the lung if the tonsils are removed. However taking antibiotics the whole year does not please us, either.
Are there any other reasons for a colonization with strepotococci? What else can we do?
Our daughter is apart from her small height and weight active and fit, the FEV1 value in the lung function is 100%, the small airways at about 50-60%.
Many thanks for your help
we got the following answer from Prof. Assen Koitschev, head of the pediatric ENT department at the Olga Hospital, Stuttgart, Germany:
"the guidelines (German) for tonsillectomy have been renewed in 2016 to a great extent. The indication criteria for a tonsillectomy in childhood had been markedly tightened....As a operative alternative is the tonsillotomy, where the tonsils are only made smaller.
In this special case of a child with CF the guidelines statement is more difficult. The clinical findings and the age of the child are some criteria. A tonsillectomy at kindergarten age is very rare. Here we
recommend nearly exclusively a tonsillotomy.
An exception are the periodic fever syndromes (e.g. PFAPA).
At kindergarten age and with a story of more than one year and a clear tonsillitis as clinical and microbiologcial finding, we would recommend a tonsillectomy. In case of very large tonsils, one can discuss with the parents as a first step a tonsillotomy with the advantage of a markedly reduced morbidity and a reduced risk of bleedings, however with the increased risk of a new tonsillitis. In order this should not function, one can do the rest of the tonsillectomy in a second step.-
A longterm antibitoic treatment is of course also possible, however not a real alternative.
In summary a clear yes/no."
We hope to have helped you with our answer.
Best regards,
Annette Pfalz for ECORN-CF