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Typical presentation is one of a sore throat with bright red tonsils and unable to eat or drink. They normally have level II lymph node enlargement and maybe clinically dry.

The plan should be to:

If after 90mins they still arenít able to eat and drink anything they should be admitted with regular medication listed above.
Most however will feel much better after the analgesia and should be allowed home (penicillin V 500mg QDS 7/7), with no follow up needed.

So the summary is only admit patients with tonsillitis if they are unable to eat or drink.


Similar presentation to tonsillitis but they also have cervical lymphadenopathy and abdominal pain. They classically have petechial rash on their soft palate with a white exudate over the tonsils.
If the GF screen is positive treat as per tonsillitis and advise them not to be involved with contact sports for 2-3 months due to the risk of splenic rupture. If the patient is a rugby player or something Ė advise them that they can only go back to playing contact sports once an ultrasound has confirmed they no longer have hepatosplenomegaly.
Remember a negative glandular fever doesnít mean they donít have glandular fever (in children the false negative rate can be almost 50%). Speak to your biochemist about a more definitive test.

DO NOT GIVE THESE PATIENTS ANY AMOXICILLIN. Only Pencillin V for all sore throat patients.

Further Reading

eMedicine - Sore Throat : Article by David A Halperin, MD

eMedicine - Tonsillitis and Peritonsillar Abscess : Article by Udayan K Shah

eMedicine - Infectious Mononucleosis : Article by Burke A Cunha

eMedicine - Mononucleosis and Epstein-Barr Virus Infection : Author: Nicholas John Bennett,


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