What are the recommended follow-up steps for a patient with tonsillitis who does not improve after initial treatment?

If a patient with tonsillitis does not improve after initial treatment, the following follow-up steps are recommended:

• Advise the patient to seek medical review if symptoms have not improved after 3 to 4 days of antibiotic therapy, to consider alternative diagnoses or adjust treatment.
• If pain does not improve after 3 days or fever persists above 38.3°C, reassess the need for antibiotic treatment or alternative diagnoses.
• If the patient develops difficulty swallowing saliva or liquids, breathing difficulties, or any one-sided neck or throat swelling, urgent medical advice should be sought to reassess the need for hospital admission.
• For patients with severe recurrent tonsillitis (e.g., more than 7 episodes in 1 year, 5 per year for 2 years, or 3 per year for 3 years), referral to an ear, nose, and throat (ENT) specialist is advised as they may benefit from tonsillectomy.
• Consider hospital admission if there are signs of systemic illness, dehydration, abscess formation, or airway compromise.

Routine follow-up is not required unless these criteria are met, but patients should be clearly advised on when to seek further medical help.