Algorithm of Tonsillitis

ALGORITHM OF TONSILLITIS Patient with signs and symptoms of tonsillitis 5 or more times a year?



 YES

NO

CHRONIC TONSILLITIS

ACUTE TONSILLITIS

 Appropriate antibiotics* antibiotics*

BACTERIAL   BACTERIAL (sore throat/dysphagia, fever, patchy discrete exudates, tender and enlarged anterior cervical nodes)

>Amoxicillin (Pediatric dose: 50-100mg/kg/day in 3-4 >Amoxicillin (Pediatric divided doses, Adult dose: 1-4g/day in 3-4 divided doses)   

Supportive management**

>Adequate fluid intake, warm saline gargle, bed rest, use of analgesics and antipyretics, good oral hygiene 

Consider tonsillectomy

 YES

Supportive management*

GABHS (via throat swab culture)



>Adequate fluid intake, warm saline gargle, bed rest, use of analgesics and antipyretics, good oral hygiene 

NO

 YES 

 Appropriate antibiotics* + cephalosporin Supportive management**

NO

 

 Appropriate antibiotics* antibiotics* Supportive management**

RESOLUTION

 YES

NO

Consider Tonsillectomy

Throat swab

 YES Confirms GABHS NO Reassess

Revise antibiotics: >Clindamycin (Pediatric dose: 20-30mg/kg/day in 3 or 4 divided doses, Adult dose: 150-300mg in 3 or 4 divided does), rd 3  gen. cephalopsporins, higher gen. macrolides

RESOLUTION

 YES

NO Consider tonsillectomy

Reassess

Clinical Practice Guidelines Guidelines of the Philippine Society of Otolaryngology-Head and Neck Surgery