Controversies in the management of acute tonsillitis: an evidence‐based review

Abstract

Management of acute tonsillitis within a secondary care setting largely consists of anecdotal or relatively low-quality evidence. Thus, much evidence from management comes from expert opinion or practice within a primary care setting. Management across the UK can also vary greatly. An evidence-based review of best practice has been presented here, but further evidence will be required in the future examining the significance of corticosteroids and antibiotic administration in this patient cohort specifically, ensuring practice is evidence based and clinically relevant.

Outpatient management of patients with acute tonsillitis and peritonsillar abscess in ninety adult patients

“…1) was devised based upon the aforementioned current evidence base. [3][4][5][6] Patients already able to eat and drink prior to treatment were excluded from the protocol; such cases were expected to be managed as outpatients in our Trust. Patients unable to eat and drink were then stratified according to risk level, with the aim of identifying patients who were likely to require at least 24 hours' admission.…”

“…Recent evidence-based reviews have provided guidance for the management of these patients, 3,4 and single-centre studies have recommended protocols for the outpatient management of tonsillitis 5 and peritonsillar abscess. 6 Given the range of similarities in the management of these conditions and the increasing pressure on inpatient beds, we developed a unified protocol for managing patients presenting to our Trust.…”

Peritonsillar abscess may not always be a complication of acute tonsillitis: A prospective cohort study

“…We also observed that afebrile AT patients have lower S-CRP and higher S-Amyl levels than AT patients with fever. One could speculate that salivary gland activation sometimes occurs in AT, though this hypothesis has not been presented previously [4, 29]. AT patients with unilateral symptoms had lower S-CRP and higher S-Amyl levels than patients with bilateral throat pain, which could also indicate activity in the minor salivary glands.…”

BeSMART2: What is the Best Supportive Management for Adults Referred with Tonsillopharyngitis? Our experience surveying the attitudes of 80 patients and professionals

“…Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. This is recognised by Bird et al in their review: more evidence is needed in order to improve the patient experience and to streamline care between primary and secondary care institutions.…”