THE ROLE OF BACTERIAL BIOFILMS IN RECURRENT TONSILLITIS IN THE PEDIATRIC POPULATION: PATHOGENESIS, ANTIBIOTIC RESISTANCE, AND FUTURE THERAPEUTIC PERSPECTIVES
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5568Keywords:
Recurrent Tonsillitis, Bacterial Biofilms, Pediatric Otorhinolaryngology, Antimicrobial Resistance, Palatine Tonsils, Waldeyer's RingAbstract
Recurrent tonsillitis (RT) in children is a major therapeutic problem. It has historically been managed with systemic antibiotics or surgery. For decades, medical understanding relied entirely on the planktonic model of bacterial infection. Modern microbiology and advanced imaging techniques changed this view. Recurrent exacerbations are actually rooted in structured bacterial communities known as biofilms. This review analyzes the pathogenesis of biofilm formation within the palatine tonsils. We unravel the exact mechanisms of biofilm-mediated antimicrobial resistance and evaluate new therapies. The data draws upon an extensive body of recent literature, including scanning electron and confocal laser microscopy findings. These studies map the anatomical predilection of tonsillar crypts for biofilm sequestration. The extracellular polymeric substance (EPS) and metabolically dormant persister cells explain the frequent failure of standard beta-lactam therapies like Penicillin V. This happens even when bacteria appear susceptible in vitro. We explore non-surgical antibiofilm strategies. These include physical disruption, bacteriophage therapy, endolysins, and nanotechnology. We view these against evolving clinical indications for adenotonsillectomy. A transition toward biofilm-targeted therapeutics is an absolute clinical necessity to reduce the socio-economic and physiological burden of recurrent pediatric upper respiratory tract infections.
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Copyright (c) 2026 Ariadna Bakier, Kornelia Domagała, Małgorzata Anna Ziółek, Magdalena Maroszek, Kamil Szymczak, Bartosz Janik, Jakub Cegielski, Nikodem Mozgała, Filip Gałązka, Jakub Ślęzak, Albert Wiatr, Agata Olecka
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