It started with a sore throat, fever and chills. My GP started me on oral abx but I found it increasingly difficult to swallow. I was admitted for a day in hospital for iv abx and steroids to bring down the swelling. It's getting better now. Thank goodness it's my first time I've had to be admitted to hospital for tonsillitis.
Further Hx: Pt has completed 7/7 2g Cephazolin iv. Noted allergies to cetirimide and penicillin (rash).
O/E: Mildly sore on R side of throat. A bit of pus is visible on the posterior aspect of the tonsils. The tonsils are enlarged bilaterally and symmetrically but not erythematous.
Plan: Discharge the patient home on oral abx.
What antibiotics would be suitable? More importantly, what's missing from the plan?
Cephalexin 5/7 500mg BD. GP to r/v 7/7
Cephazolin is related to cephalexin, and while both are penicillins, it's likely she will tolerate cephalexin.
The last sentence in the history should ring a bell. On further questioning, this patient has has tonsillitis five times over the last two years. She was managed previously by her GP.
She needs to be informed of the risk of endocarditis and rheumatoid arthritis with recurrent tonsillitis. B-Haemolytic streptococcal infections can cause endocarditis which is why she should be considering a tonsillectomy.
Further Plan: Surgical r/v regarding tonsillectomy. Pt to d/w GP regarding referral to surgeon for elective procedure.
Medicolegal: Document that the patient has been advised of the risk of endocarditis and to seek surgical opinion.
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