Is tonsillitis most commonly caused by a bacterial, viral or fungal infection?
Viral
In the cases of bacterial tonsillitis, the most common causative organism is…
Group A streptococcus, e.g. strep pyogenes
Which criteria/scoring tools can be used to predict the probability that tonsillitis has a bacterial cause?
- Centor criteria
- FeverPAIN score
What are the components of the FeverPAIN score? How is the score interpreted?
- Fever
- Purulence
- Attended within 3 days of symptom onset
- Inflamed tonsils
- No cough/coryza
If the FeverPAIN score is 4 or more, consider antibiotics
What is the first-line choice of antibiotic for bacterial tonsillitis? What is the duration of treatment?
What if the patient is penicillin allergic?
Penicillin V (phenoxymethylpenicillin) for 10 days
If penicillin allergic, prescribe clarithromycin
Give some examples of complications of tonsillitis
- Peritonsillar abscess (quinsy)
- Scarlet fever
- Rheumatic fever
- Post-streptococcal glomerulonephritis
What are the characteristic symptoms of quinsy?
- Trismus (patient is unable to open their mouth)
- Change in voice (“hot potato voice”)
- Swelling/erythema in the area beside the tonsils
Is quinsy most commonly caused by a bacterial, viral or fungal infection?
What is the most common causative organism?
Bacterial
Group A streptococcus, e.g. strep pyogenes
Describe the management of quinsy
- Urgent referral to ENT
- Incision and drainage
- Broad-spectrum antibiotics, e.g. co-amoxiclav
What are the indications for tonsillectomy?
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
