Head and Neck A3


Tonsillitis management

Most cases of tonsillitis resolve spontaneously without medical intervention (analgesia and hydration are mainstay therapy). It is difficult to distinguish between viral tonsillitis and bacterial tonsillitis/tonsillopharyngitis. The Centor criteria is now commonly used to decide whether or not antibiotics should be used.

Centor criteria:

  • Tonsillar exudate
  • Tender anterior cervical lymphadenopathy or lymphadenitis
  • History of fever (>38 degree Celsius)
  • Absence of cough

Each of the Centor criteria score 1 point (maximum score of 4). Antibiotics should be considered if the patient scores ≥2 points.

The most likely causative organism is group A streptococcus (Streptococcus pyogenes), which is a gram-positive aerobe. Phenoxymethylpenicillin (Penicillin V) is the antibiotics of choice (macrolides if penicillin-allergic). Amoxicillin and co-amoxiclav should be avoided as they can precipitate a severe scarring rash in patients with infectious mononucleosis (glandular fever). 

Severe cases of tonsillitis may require hospital admission. Indications for hospital admission include systemically unwell child, dehydration from not being able to drink for a prolonged period of time or any suggestion of airway compromise.

Following the acute episode, referral to ENT for tonsillectomy should be considered if SIGN criteria are met: 7 or more significant sore throats (with impact to patient and family) in the preceding 12 months, 5 or more episodes in each of the preceding two years, or 3 or more in each of the preceding three years.

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