A 4 year old boy presents with fever, sore throat and lymphadenopathy. The diagnosis of tonsillitis has been made. He had 3 episodes last year. What is the most appropriate management for this patient?

The key is B. Paracetamol/ibuprofen. This is wrong key! Correct key is C. Oral penicillin V. [One of

the indications of antibiotics is presence of three or more centor criteria and as the patient fulfilled

three centor criteria he should be given antibiotics. patient has the following three centor criteria: 1.

history of fever 2. lymphadenopathy and 3. absence of cough.

Management of tonsillitis according to NICE guidelines are as follows:

• Antipyretic analgesics such as paracetamol and ibuprofen are of value.

• For most patients, antibiotics have little effect on the duration of the condition or the severity of

symptoms. 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 of the following Centor criteria present:

History of fever Tonsillar exudates No cough Tender anterior cervical lymphadenopathy. [Source: patient.info].

Indications for tonsillectomy:

• 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.