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).
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