Head and Neck A4


Tonsillitis management

Most cases of tonsillitis are viral. There is no additional benefit for patient being prescribed antibiotics as there are more side effects and risks than symptomatic benefit. Viral tonsillitis is a self-limiting condition and normally resolves within a week. Supportive measures such as paracetamol and/or ibuprofen with adequate fluid intake is sufficient. 

However the Centor criteria can help identify cases which are more likely to be bacterial: 

  • 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). A score of 3 or 4 suggest a 40-60% chance of having GABS and therefore antibiotics would be beneficial. Hospital admission is unnecessary unless a patient experiences worsening symptoms, stridor, becomes systemically unwell or is unable to tolerate fluids as well as solids.

If antibiotics are indicated, Phenoxymethylpenicillin 500mg QDS for 10 days is first line. In penicillin allergic patients, Clarithromycin 500mg BD for 5 days or Erythromycin 500mg BD for 5 days is used. Be careful and make sure to check the BNF Children as different ages have different doses of the above antibiotics. In addition to antibiotics, supportive measures and advice such as simple analgesia and adequate fluid intake are important.

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