ENT Ongoing management / MINIMUM INFECTION Most likely causal organisms First choice duration of antibiotic therapy 7 days Most young children presenting with Base decision to treat on ( 1 point for each of Fever, tonsillitis have a viral aetiology. Purulence, Attend within 3 days of onset or less, severely Inflamed tonsils, No cough or coryza): Provide safety netting information (verbal and written) when a watchful waiting approach is Group A streptococcus score 0-1 = 18% streptococci: use NO antibiotics taken and when antibiotics are prescribed. score 2-3: 34-40% streptococci, use back up/delayed Consider testing for EBV (EBV Consider a delayed prescribing approach. antibiotic serology) score streptococci, use immediate Ab. Based ≥4: 62-65% Consider oral switch to amoxicillin on Score validated in children 3 years and over younger – If confirmed EBV, stop Abs children are less likely to have a bacterial aetiology and are less likely to develop complications. No significant difference in pain score at day 3 in children treated with antibiotics compared to those treated with placebo (). Need to treat >4000 children with antibiotics to prevent one case of quinsy. Most children with tonsillitis do not require a throat swab. Tonsillitis For children unable to swallow tablets; amoxicillin 40mg/kg bd PO (max 1g per dose) for 7 days (2012 ). The use of amoxicillin does not significantly increase the risk For children able to swallow tablets; if age 6-12 years, penicillin V 500mg bd; if age >12 years, penicillin V 1 g bd for 7 days (see ). [azithromycin PO for 5 days for penicillin allergy] If unable to tolerate oral antibiotics, ceftriaxone IV (clindamycin if severe penicillin allergy). Ceftriaxone IV + metronidazole IV / PO 10 days Group A streptococcus Peritonsillar Anaerobes Consider oral switch to co-amoxiclav abscess (quinsy)
ENT INFECTION Most likely causal organisms First choice Ongoing management / MINIMUM duration of antibiotic therapy Tonsillitis Most young children presenting with tonsillitis have a viral aetiology. Group A streptococcus Consider testing for EBV (EBV serology) Base decision to treat on ( 1 point for each of Fever, Purulence, Attend within 3 days of onset or less, severely Inflamed tonsils, No cough or coryza): score 0-1 = 18% streptococci: use NO antibiotics score 2-3: 34-40% streptococci, use back up/delayed antibiotic score ≥4: 62-65% streptococci, use immediate Ab. Based on Score validated in children 3 years and over – younger children are less likely to have a bacterial aetiology and are less likely to develop complications. No significant difference in pain score at day 3 in children treated with antibiotics compared to those treated with placebo (). Need to treat >4000 children with antibiotics to prevent one case of quinsy. Most children with tonsillitis do not require a throat swab. For children unable to swallow tablets; amoxicillin 40mg/kg bd PO (max 1g per dose) for 7 days (2012 ). The use of amoxicillin does not significantly increase the risk For children able to swallow tablets; if age 6-12 years, penicillin V 500mg bd; if age >12 years, penicillin V 1 g bd for 7 days (see ). [azithromycin PO for 5 days for penicillin allergy] If unable to tolerate oral antibiotics, ceftriaxone IV (clindamycin if severe penicillin allergy). 7 days Provide safety netting information (verbal and written) when a watchful waiting approach is taken and when antibiotics are prescribed. Consider a delayed prescribing approach. Consider oral switch to amoxicillin If confirmed EBV, stop Abs Peritonsillar abscess (quinsy) Group A streptococcus Anaerobes Ceftriaxone IV + metronidazole IV / PO 10 days Consider oral switch to co-amoxiclav
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