Tonsillitis (930/1700)

 A 4yo boy presents with fever, sore throat and lymphadenopathy. The dx of tonsillitis has been
made. He had 3 episodes last yr. What is the most appropriate management for this pt?
a. Tonsillectomy
b. Paracetamol/ibuprofen
c. Oral penicillin V
d. IV penicillin
e. None
































answer: C
Centor criteria met: acute tonsillitis with fever, no cough and lymphadenopathy. 

In most children referral for tonsillectomy should only be considered if all of the following criteria are met:

• The child has five or more episodes of acute sore throat per year, documented by the parent or clinician.
• Symptoms have been occurring for at least a year.
• The episodes of sore throat have been severe enough to disrupt the child's normal behaviour or day-to-day functioning.

The National Institute for Health and Care Excellence (NICE) suggests that indications for antibiotics include:

• Features of marked systemic upset secondary to the acute sore throat.
• Unilateral peritonsillitis.
• A history of rheumatic fever.
• An increased risk from acute infection (such as a child with diabetes mellitus or immunodeficiency).
• Acute tonsillitis with three or more Centor criteria present (History of fever, Tonsillar exudates, No cough, Tender anterior cervical lymphadenopathy)

The antibiotic of choice is a-10 day course of phenoxymethylpenicillin (Penicillin V).