Tonsillitis
Inflammation of the palatine tonsils, usually viral but sometimes bacterial (chiefly group A Streptococcus), where clinical scoring rather than routine testing decides who actually benefits from an antibiotic.
In a nutshell
Tonsillitis is inflammation of exposed lymphoid tissue sampling swallowed and inhaled pathogens, most often viral. Clinical scores target the minority of bacterial (group A streptococcal) cases for antibiotics, while missed glandular fever and amoxicillin together produce a characteristic drug rash.
Classic presentation
A child or young adult with sore throat, fever, painful swallowing and erythematous, exudative tonsils with tender anterior cervical nodes.
Key points
- Most tonsillitis is viral and self-limiting; Centor and FeverPAIN scores target antibiotics to those most likely to have bacterial infection.
- Glandular fever (EBV) can mimic bacterial tonsillitis closely, with more prominent malaise, posterior cervical lymphadenopathy and splenomegaly.
- Amoxicillin given in glandular fever causes a florid, non-allergic maculopapular rash: avoid it when EBV infection is suspected.
- Trismus, uvular deviation and a muffled voice indicate peritonsillar abscess, a local spread of infection needing urgent drainage, not more antibiotics alone.
- Recurrent, severe tonsillitis affecting quality of life is the usual indication for considering tonsillectomy referral.
First-line investigation
Clinical assessment using the Centor or FeverPAIN score; a throat swab is not routinely needed.
First-line management
Analgesia and safety-netting for most patients, with antibiotics reserved for those with a higher clinical score.
Exam traps
- A sore throat with exudate and lymphadenopathy is not automatically streptococcal: glandular fever must be considered, especially in a teenager or young adult with marked malaise.
- Amoxicillin in suspected glandular fever is a classic exam trap because of the rash it provokes.
- Trismus and uvular deviation point to quinsy, a surgical emergency, not just severe tonsillitis needing stronger antibiotics.
Educational content pending clinical review. Not medical advice.