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Paediatric tonsillitis antibiotic choice — GPhC CRA MCQ

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ModerateClinical TherapeuticsPaediatric tonsillitis antibiotic choiceGPhC CRA

A 7-year-old boy presents with a five-day history of sore throat, fever, and malaise. On examination by the pharmacist under the Pharmacy First service, he has tonsillar exudate and tender anterior cervical lymphadenopathy. His FeverPAIN score is 4. He has no drug allergies. What is the most appropriate action?

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Correct answer: C — Supply phenoxymethylpenicillin 250 mg four times daily for five to ten days

With a FeverPAIN score of 4, the likelihood of streptococcal infection is moderate to high, and NICE recommends offering an antibiotic or a delayed prescription. Phenoxymethylpenicillin is first-line for streptococcal tonsillitis in children. The dose of 250 mg four times daily is appropriate for a child of this age. Amoxicillin should be avoided if infectious mononucleosis is a differential, as it can cause a widespread rash. Clarithromycin is reserved for penicillin allergy.

Reference: NICE NG84 Sore Throat; BNF for Children