Acute Tonsillitis

Question 1

what is it?

Answer 1

majority are viral infections - EBV, rhinovirus, influenza, parainfluenza, enterovirus and adenovirus
5-30% are bacterial infections
throat swab not recommended - too much commensal bacteria doesn’t really work

Question 2

what are the common organisms causing chronic tonsillar disease?

Answer 2

streptococcus pyogenes 
H. influenza 
S. aureus 
Streptococcus pneumonia 
39% are beta-lactamase producing (BLPO)

Question 3

how does chronic tonsillitis present?

Answer 3

chronic sore throat 
malodorous breath 
presence of tonsillitis 
peritonsillar erythema 
persistent tender cervical lymphadenopathy 
surgery controversial

Question 4

how does viral tonsillitis present?

Answer 4

malaise 
sore throat, mild analgesia requirement 
temperature 
able to undertake near normal activity 
possible lymphadenopathy 
lasts 3-4 days

Question 5

how does bacterial tonsillitis present?

Answer 5

systemic upset 
fever 
odynophagia 
halitosis 
unable to work/school 
lymphadenopthy 
lasts roughly a week and needs antibiotics to settle

Question 6

how do you evaluate tonsillitis?

Answer 6

feverPAIN criteria used to predict likelihood of a bacterial - streptococcal cause
2 or 3 points then consider delayed antibiotic prescription
4 or 5 points then treat with antibiotics

Question 7

what are the points of feverPAIN?

Answer 7

fever - during previous 24 hours
Purulence - pus on tonsils
Attend rapidly - within 3 days of symptom onset
severely Inflamed tonsils
No cough or coryza (inflammation of the mucous membrane in the nose)

Question 8

how is it managed in primary care?

Answer 8

supportive 
- eat and drink 
- rest 
- OTC analgesia, paracetamol, NSAID 
Antibiotic 
- penicillin 500mg qid for 10 days 
- clarithromycin if allergic 
- Don't give amoxicillin

Question 9

how is it managed in hospital?

Answer 9

IV fluids
IV antibiotics
Steroids
Surgery - strict guidelines, reduced tonsillectomy rate - controversial procedure