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

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

BACKGROUND: Patients admitted with acute tonsillitis generate a substantial workload for the National Health Service (NHS), placing huge financial pressures on an already overstretched budget.

OBJECTIVE OF REVIEW: Due to the difficulty of accurate diagnosis and varying practices across the UK, there exist a number of controversial areas and non-standardised practice. These will be highlighted and tackled within this article.

TYPE OF REVIEW AND SEARCH STRATEGY: A literature review, last performed in September 2013, searched PubMed citing variations on the areas of controversies with 'tonsillitis', 'pharyngitis' and 'pharyngotonsillitis' - from 1956 to present with language restrictions. Excluded articles included those regarding sore throat after tonsillectomy and peritonsillar abscess.

EVALUATION METHOD: Titles and abstracts were initially screened, and full text of potentially relevant articles obtained. The bibliographies of articles were searched for relevant references. The references were then compiled and reviewed independently by two authors (JB & TB), overseen by the senior author (EK).

RESULTS: (i) Diagnosis and investigation: Use of the Centor criteria is inadequate within the secondary care setting. Blood testing is unnecessary in the majority of cases where patients do not require admission, as they are unlikely to change management. (ii) Antibiotics: Antibiotics are likely to be indicated in all those presenting to secondary ENT care, with penicillin being the antibiotic of choice for first-line therapy. (iii) Corticosteroids: Moderate evidence supports the benefit of steroid administration in this patient cohort, advocating a single dose initially followed by reassessment. (iv) Analgesia: Paracetamol and NSAIDs have good evidence of action. Codeine should be used with caution in the paediatric population. (v) Reduced admission rates and early discharge: There is evidence suggesting that a trial of medical therapy prior to admission is beneficial in reducing rates of admission and length of stay.

CONCLUSIONS: 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.

Acute Disease, Adrenal Cortex Hormones, Analgesia, Anti-Bacterial Agents, Evidence-Based Medicine, Humans, Patient Discharge, Tonsillitis, United Kingdom, Journal Article, Review
1749-4478
368-374
Bird, J.H.
71c3a83a-3336-457d-8eaa-1025522a3370
Biggs, T.C.
887596b4-f2ad-4067-8f01-5f2cfe1ae394
King, E.V.
d85e0e8f-7295-4912-9052-646a790d99db
Bird, J.H.
71c3a83a-3336-457d-8eaa-1025522a3370
Biggs, T.C.
887596b4-f2ad-4067-8f01-5f2cfe1ae394
King, E.V.
d85e0e8f-7295-4912-9052-646a790d99db

Bird, J.H., Biggs, T.C. and King, E.V. (2014) Controversies in the management of acute tonsillitis: an evidence-based review. Clinical Otolaryngology, 39 (6), 368-374. (doi:10.1111/coa.12299).

Record type: Review

Abstract

BACKGROUND: Patients admitted with acute tonsillitis generate a substantial workload for the National Health Service (NHS), placing huge financial pressures on an already overstretched budget.

OBJECTIVE OF REVIEW: Due to the difficulty of accurate diagnosis and varying practices across the UK, there exist a number of controversial areas and non-standardised practice. These will be highlighted and tackled within this article.

TYPE OF REVIEW AND SEARCH STRATEGY: A literature review, last performed in September 2013, searched PubMed citing variations on the areas of controversies with 'tonsillitis', 'pharyngitis' and 'pharyngotonsillitis' - from 1956 to present with language restrictions. Excluded articles included those regarding sore throat after tonsillectomy and peritonsillar abscess.

EVALUATION METHOD: Titles and abstracts were initially screened, and full text of potentially relevant articles obtained. The bibliographies of articles were searched for relevant references. The references were then compiled and reviewed independently by two authors (JB & TB), overseen by the senior author (EK).

RESULTS: (i) Diagnosis and investigation: Use of the Centor criteria is inadequate within the secondary care setting. Blood testing is unnecessary in the majority of cases where patients do not require admission, as they are unlikely to change management. (ii) Antibiotics: Antibiotics are likely to be indicated in all those presenting to secondary ENT care, with penicillin being the antibiotic of choice for first-line therapy. (iii) Corticosteroids: Moderate evidence supports the benefit of steroid administration in this patient cohort, advocating a single dose initially followed by reassessment. (iv) Analgesia: Paracetamol and NSAIDs have good evidence of action. Codeine should be used with caution in the paediatric population. (v) Reduced admission rates and early discharge: There is evidence suggesting that a trial of medical therapy prior to admission is beneficial in reducing rates of admission and length of stay.

CONCLUSIONS: 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.

Full text not available from this repository.

More information

Accepted/In Press date: 18 July 2014
e-pub ahead of print date: 23 November 2014
Published date: December 2014
Additional Information: © 2014 John Wiley & Sons Ltd.
Keywords: Acute Disease, Adrenal Cortex Hormones, Analgesia, Anti-Bacterial Agents, Evidence-Based Medicine, Humans, Patient Discharge, Tonsillitis, United Kingdom, Journal Article, Review

Identifiers

Local EPrints ID: 416835
URI: https://eprints.soton.ac.uk/id/eprint/416835
ISSN: 1749-4478
PURE UUID: 2436aec5-a6e6-46b3-b0da-52de23b85c19

Catalogue record

Date deposited: 11 Jan 2018 17:30
Last modified: 13 Mar 2019 19:02

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