Paeds Acute tonsillitis

Question 1

CENTOR score

Answer 1

Cough absent
Exudate (tonsillar)
Nodes (tender anterior cervical)
Temperature (fever >38°C)
1 point for each criteria - total of 4 points
- 0-2 points - Abx not reuqired
- 3-4 points - Abx indicated

Question 2

What are the most common causative organisms of acute tonsillitis in children?

Answer 2

1. Viruses (most common)
2. Group A streptococcus (Streptococcus pyogenes) is the main bacterial cause

Question 3

What are the typical symptoms of acute tonsillitis in children?

Answer 3

Sore throat
pain on swallowing
fever (>38°C)
tonsillar exudate
tonsillar erythema
enlarged anterior cervical lymph nodes
headache
abdominal pain
nausea/vomiting

Question 4

When are antibiotics indicated for acute tonsillitis in children?

Answer 4

Only if high likelihood of bacterial infection (e.g., FeverPAIN or Centor score ≥3), severe symptoms, or risk of complications. Otherwise, consider a back-up (delayed) prescription.

Question 5

What is the first-choice antibiotic and duration if indicated?

Answer 5

Phenoxymethylpenicillin for 5-10 days. If allergic, use clarithromycin or erythromycin

Question 6

What is the the management for non-bacterial/CENTOR 0-2 of acute tonsillitis in children?

Answer 6

Self-care and symptomatic relief: paracetamol or ibuprofen for pain/fever, adequate fluids, rest. Most cases are self-limiting

Question 7

What are red flag symptoms requiring urgent review or referral?

Answer 7

Difficulty breathing, stridor, drooling, inability to swallow fluids, severe neck pain/stiffness, trismus, or suspicion of peritonsillar abscess (quinsy)