{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:58:05Z","timestamp":1790013485359,"version":"4.0.1"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,11,23]],"date-time":"2014-11-23T00:00:00Z","timestamp":1416700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients admitted with acute tonsillitis generate a substantial workload for the National Health Service (<jats:styled-content style=\"fixed-case\">NHS<\/jats:styled-content>), placing huge financial pressures on an already overstretched budget.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective of review<\/jats:title><jats:p>Due to the difficulty of accurate diagnosis and varying practices across the<jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>, there exist a number of controversial areas and non\u2010standardised practice. These will be highlighted and tackled within this article.<\/jats:p><\/jats:sec><jats:sec><jats:title>Type of review and search strategy<\/jats:title><jats:p>A literature review, last performed in September 2013, searched PubMed citing variations on the areas of controversies with \u2018tonsillitis\u2019, \u2018pharyngitis\u2019 and \u2018pharyngotonsillitis\u2019 \u2013 from 1956 to present with language restrictions. Excluded articles included those regarding sore throat after tonsillectomy and peritonsillar abscess.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evaluation method<\/jats:title><jats:p>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 (<jats:styled-content style=\"fixed-case\">JB<\/jats:styled-content>&amp;<jats:styled-content style=\"fixed-case\">TB<\/jats:styled-content>), overseen by the senior author (<jats:styled-content style=\"fixed-case\">EK<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>(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<jats:styled-content style=\"fixed-case\">ENT<\/jats:styled-content>care, with penicillin being the antibiotic of choice for first\u2010line 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<jats:styled-content style=\"fixed-case\">NSAID<\/jats:styled-content>s 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Management of acute tonsillitis within a secondary care setting largely consists of anecdotal or relatively low\u2010quality evidence. Thus, much evidence from management comes from expert opinion or practice within a primary care setting. Management across the<jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>can also vary greatly. An evidence\u2010based 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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12299","type":"journal-article","created":{"date-parts":[[2014,11,24]],"date-time":"2014-11-24T05:17:25Z","timestamp":1416806245000},"page":"368-374","source":"Crossref","is-referenced-by-count":26,"title":["Controversies in the management of acute tonsillitis: an evidence\u2010based review"],"prefix":"10.1111","volume":"39","author":[{"given":"J.H.","family":"Bird","sequence":"first","affiliation":[{"name":"Department of ENT Surgery University Hospital Southampton NHS Foundation Trust Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.C.","family":"Biggs","sequence":"additional","affiliation":[{"name":"Department of ENT Surgery University Hospital Southampton NHS Foundation Trust Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.V.","family":"King","sequence":"additional","affiliation":[{"name":"Department of ENT Surgery Poole NHS Foundation Trust Poole UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,11,23]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Hospital episode statistics online.www.hesonline.nhs.uk(last accessed 21st September 2013)"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1201\/b15118"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.22.2912"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7082.722"},{"key":"e_1_2_8_6_1","first-page":"3","article-title":"Centor criteria in children in a paediatric emergency department: for what it is worth","volume":"22","author":"Roggen I.","year":"2013","journal-title":"BMJ Open."},{"key":"e_1_2_8_7_1","first-page":"485","article-title":"Case against the use of throat culture in the management of streptococcal pharyngitis","volume":"8","author":"Caplan C.","year":"1979","journal-title":"J. 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