Tonsillitis, Complicated (Peritonsillar Cellulitis, Peritonsillar Abscess)
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J03.9 DESCRIPTION An infective process involving the tonsils with spread of infection into the adjacent tissue. It must be differentiated from hypertrophy of the tonsils without infection and a viral upper respiratory tract infection (these are associated with rhinorrhoea , nasal conges
General and supportive measures
ICD-10 code: J03.9
DESCRIPTION
An infective process involving the tonsils with spread of infection into the adjacent tissue. It must be differentiated from hypertrophy of the tonsils without infection and a viral upper respiratory tract infection (these are associated with rhinorrhoea, nasal congestion and cough).
Local complications include peritonsillar abscess (quinsy), and parapharyngeal extension.
Systemic complications include glomerulonephritis, rheumatic fever and bacterial endocarditis.
DIAGNOSTIC CRITERIA
Clinical
- Pyrexia, malaise.
- Sore throat, dysphagia, drooling, trismus.
- Enlarged, inflamed tonsils, often with superficial pus visible in crypts.
- Earache (referred to as otalgia).
- Tender and enlarged cervical lymph nodes.
Signs of peritonsillar abscess/cellulitis:
- Usually unilateral.
- Soft palate and uvula on the infected side are oedematous and displaced medially towards the uninvolved side.
- Trismus.
Investigations
- Blood microscopy, culture and sensitivity.
GENERAL AND SUPPORTIVE MEASURES
If necessary, maintain the airway.
MEDICINE TREATMENT
Empiric antibiotic therapy
- Initiate antibiotic treatment immediately even if transfer of the patient is anticipated.
- Adjust antibiotic therapy based on culture results, if available.
Early complications may be treated with antibiotic therapy alone.
- Amoxicillin/clavulanic acid, IV, 25 mg/kg/dose of the amoxicillin component 8 hourly. (do not exceed 10 mg/kg/day of the clavulanic acid component).
As soon as there is a response and patient can tolerate oral medication:
- Amoxicillin/clavulanic acid, oral, 45 mg/kg/dose of amoxicillin component, 12 hourly for 10 days (amoxicillin/clavulanic acid in a ratio of 14:1).
- Maximum dose of amoxicillin component: 1.5 g 12 hourly.
Adjust antibiotics once sensitivity results are obtained.
Penicillin allergy
See: Drug Allergies, Allergies to penicillins.
For pain and fever:
- Paracetamol, oral, 15 mg/kg/dose 6 hourly as required.
See: Pain Control, Management of pain.
REFERRAL
- Tonsillitis with local complications not responding to adequate treatment.
- All cases where drainage may be required and is not available locally.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 17: Ear Nose & Throat, 17.3 Tonsillitis, Complicated (Peritonsillar Cellulitis, Peritonsillar Abscess)