Numerous saprophyte and relative or evident pathogens are present in the upper respiratory tract, either periodically or constantly. As a result of many health conditions, e.g. viral infection, an organism may become susceptible to bacterial infection. One of these conditions, especially common in childhood, is the recurrence of acute tonsillitis. If treatment does not eradicate the invading bacteria a child may subseqquently develop chronic tonsillitis. Because of its mutability, a knowledge of normal tonsillar flora is then necessary to condition the proper use of antimicrobial therapy. The aim of our study was to examine swabs taken from the surface and from the inside of tonsils. The material consisted of children suffering from chronic tonsillitis and qualified for tonsillectomy.

30 children aged 4.5 to 17 (average 10), qualified for tonsillectomy because of chronic tonsillitis, were examined. All of them were treated at the Polyclinic because of recurrent acute tonsillitis. The children were not administered antibiotics for longer than 3-4 weeks before the surgical intervention. In each case 4 swabs, 2 from the surface and 2 from the inside of each tonsil were taken during tonsillectomy. Swabs were placed in test-tubes with a transport medium suitable for aerobic and anaerobic bacteria. The material was sent immediately to a microbiological laboratory. Inoculation, identification and estimation of the resistance and sensitiveness to antibiotics were carried out according to standard procedures.

Cultures of 120 swabs taken from 30 children revealed 19 pathogens including 15 strains of aerobic and anaerobic (gram + and gram -) bacteria. On average 34 (only once 5) strains were isolated. In swabs taken from the surface of the tonsil of all children, 3 strains of bacteria, typical of the upper respiratory tract were always found. They were Str. Orale, Peptostr. Sp., Neisseria sp. and sometimes Lactobacillus sp., Actinomyces Myeri and Noestundi, Candida sp., Eubacterium, Bacteroides sp. and Orale. Four strains were identified as pathogens: St. Aureus was found in 14 children (46.2%), Str. Pyogenes (type A) in 12 children (40.6%), E. Coli in 2 children (6.6%), Klebsiella Oxytoca in 2 children (6.6%). Antibiograms confirmed their susceptibility to most antibiotics. Str. Pyogenes was sensitive to penicillin, ampicillin and cephalosporins of generation I. None of the St. Aureus strains were meticilin resistant but all of them were refractory to penicillin. E. Coli presented typical sensitiveness to cephalosporins of II generation and refractoriness to penicillin. Similarly Klebsiella Oxytoca presented a typical pattern of sensitiveness and refractoriness. Swabs taken from the surface and from the inside of tonsils were compared. Pathogens Str. Pyogenes and St. Aureus were always found in both places simultaneously.

Bacterial resistance has occurred and disseminated because of widespread administration of antibiotics. Its frequent cause is an inappropriate antibiotic therapy in cases of acute tonsillitis. Most important clinically is Streptococcus Pyogenes (1, 2). Acute recurrent and chronic tonsillitis is very common in children and young adults. It often necessitates one of the most common surgical procedures in paediatrics - tonsillectomy. In children from Lower Silesia only 2 strains (86. 8%) were identified as a causative factor of chronic tonsillitis. Str. Pyogenes and St. Aureus are frequently isolated from the human upper respiratory tract, opposite to E. Coli and Klebsiella (1, 2, 4). Both bacteria strains were always found in swabs taken from the surface and from the inside of tonsils. The pathogen was each time sensitive to most of the antibiotics routinely used at Polyclinic (3, 5). But almost half of the tonsils were colonised by St. Aureus which is originally refractory to penicillin. In empirical therapy the administration of antibiotics belonging only to a spectrum comprising both, Str. Pyogenes and St. Aureus, has to be taken into consideration. In our material both strains were sensitive to some cephalosporins, clindamicin and chinolons. However, because of known adverse effects, the use of chinolons in children cannot be fully recommended. In the treatment of acute tonsillitis the cephalosporins II generation seem to be the antibiotics of choice.

1. Str. Pyogenes and St. Aureus are the most common causative factors of chronic tonsillitis in children from Lower Silesia.

2. Swabs taken properly from only the surface of tonsils were proved to have value.