Acute Tonsillitis or Quinsy

Micro-organism

Strep. pyogenes

Qunisy can be polymicrobial

First Line

Phenoxymethylpenicillin PO for 5-10 days (10 days if Scarlet fever)

Use IV benzylpenicillin if severe

Second line: mild intolerance or mild skin reaction

Clarithromycin PO for 5 days

Ceftriaxone IV if severe

Anaphylaxis (including severe skin reaction) to penicillin / cephalosporins

Clarithromycin PO for 5 days

Severe - Vancomycin IV + clindamycin IV/PO for 5 days

Notes

Only use IV route if patient unable to swallow

It is difficult to differentiate bacterial from viral infection - see information on Sore Throat

If Quinsy - contact ENT

CKS - Scarlet Fever