What safety netting advice should be given to patients with tonsillitis?

Safety Netting Advice for Tonsillitis

Patients with tonsillitis should be closely monitored through regular clinic visits with accurate documentation of each episode, including symptoms, physical findings, test results, school absences, and quality of life issues to properly assess the impact of recurrent pharyngotonsillitis. 1

Watchful Waiting and Documentation

• Watchful waiting is strongly recommended for patients with recurrent throat infections if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years, or <3 episodes per year in the past 3 years 1
• Watchful waiting does not mean inaction - patients should be monitored closely with regular follow-up visits 1
• Each episode of tonsillitis should be thoroughly documented, including:
  • Temperature (especially if ≥38.3°C/101°F)
  • Presence of cervical adenopathy
  • Tonsillar exudate
  • Results of rapid antigen detection testing or culture for group A beta-hemolytic streptococcus 1
  • Days of school absence
  • Impact on quality of life 1

Warning Signs Requiring Immediate Medical Attention

• Patients and caregivers should seek immediate medical attention for:
  • Any bleeding from the tonsils, even minor bleeding, as it may precede more serious hemorrhage 2
  • Difficulty breathing or swallowing 3
  • Severe pain unresponsive to prescribed pain medication 4
  • Signs of dehydration (dry mouth, decreased urination, dizziness) 5
  • Persistent high fever (>38.3°C/101°F) despite treatment 1, 3
  • Development of a peritonsillar abscess (severe pain, difficulty opening mouth, "hot potato" voice) 1

Medication Safety Advice

• For pain management:
  • Ibuprofen and acetaminophen are recommended for pain control 1, 4
  • Codeine should not be administered to children younger than 12 years 1
  • Follow proper dosing guidelines for all medications 6
  • Complete the full course of antibiotics if prescribed, even if symptoms improve 1, 3

When to Consider Tonsillectomy

Advise patients and caregivers about potential indications for tonsillectomy:

• Frequency criteria (with proper documentation):
  • ≥7 episodes in the past year, OR
  • ≥5 episodes per year for 2 years, OR
  • ≥3 episodes per year for 3 years 1
• Each documented episode should include at least one of: temperature ≥38.3°C, cervical adenopathy, tonsillar exudate, or positive test for group A beta-hemolytic streptococcus 1
• Modifying factors that may favor tonsillectomy even if frequency criteria aren't met:
  • Multiple antibiotic allergies/intolerance
  • PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and adenitis)
  • History of >1 peritonsillar abscess 1

Post-Tonsillectomy Monitoring (If Surgery Occurs)

• Patients and caregivers should be informed that bleeding can occur up to three weeks after surgery while the wound is healing 2
• Any post-tonsillectomy bleeding, even minor, requires immediate medical attention 2
• Provide written instructions with emergency contact information and proper steps to take if bleeding occurs 2
• Patients should be monitored for persistent or recurrent symptoms after surgery 1

Special Considerations

• Patients with hereditary coagulopathy have a higher risk of hemorrhage and may require special precautions 2
• Patients with obstructive sleep-disordered breathing and tonsillar hypertrophy may have additional comorbid conditions that could improve after tonsillectomy (growth retardation, poor school performance, enuresis, asthma, behavioral problems) 1
• Group A streptococcal carriers do not generally require antimicrobial therapy as they are unlikely to spread infection and are at little risk for complications 1

Following these safety netting guidelines ensures proper monitoring of tonsillitis patients, appropriate escalation of care when needed, and helps prevent complications while avoiding unnecessary interventions.