Tonsillitis

Question 1

Is tonsillitis most commonly caused by a bacterial, viral or fungal infection?

Answer 1

Viral

Question 2

In the cases of bacterial tonsillitis, the most common causative organism is…

Answer 2

Group A streptococcus, e.g. strep pyogenes

Question 3

Which criteria/scoring tools can be used to predict the probability that tonsillitis has a bacterial cause?

Answer 3

• Centor criteria

- FeverPAIN score

Question 4

What are the components of the FeverPAIN score? How is the score interpreted?

Answer 4

• Fever
• Purulence
• Attended within 3 days of symptom onset
• Inflamed tonsils
• No cough/coryza

If the FeverPAIN score is 4 or more, consider antibiotics

Question 5

What is the first-line choice of antibiotic for bacterial tonsillitis? What is the duration of treatment?

What if the patient is penicillin allergic?

Answer 5

Penicillin V (phenoxymethylpenicillin) for 10 days

If penicillin allergic, prescribe clarithromycin

Question 6

Give some examples of complications of tonsillitis

Answer 6

• Peritonsillar abscess (quinsy)
• Scarlet fever
• Rheumatic fever
• Post-streptococcal glomerulonephritis

Question 7

What are the characteristic symptoms of quinsy?

Answer 7

• Trismus (patient is unable to open their mouth)
• Change in voice (“hot potato voice”)
• Swelling/erythema in the area beside the tonsils

Question 8

Is quinsy most commonly caused by a bacterial, viral or fungal infection?

What is the most common causative organism?

Answer 8

Bacterial

Group A streptococcus, e.g. strep pyogenes

Question 9

Describe the management of quinsy

Answer 9

• Urgent referral to ENT
• Incision and drainage
• Broad-spectrum antibiotics, e.g. co-amoxiclav

Question 10

What are the indications for tonsillectomy?

Answer 10

Number of episodes of tonsillitis required:

• 7 or more in 1 year
• 5 per year for 2 years
• 3 per year for 3 years

Other indications:

• Recurrent tonsillar abscesses (2 episodes)
• Enlarged tonsils causing difficulty breathing/swallowing