Why is it important to check his immunisation status?

o   To conclude that it is bacterial tonsillitis (example you take vaccine for disease X, so we can determine you do not have disease X) and also vaccine can show maybe you have different strain instead 

o   Determine the severity of the disease, reassure parent that it is less severe 

What is the appropriate course of action for this patient?

o   Antibiotics 

o   Red flag – more than 4 days should refer to a GP a and get antibiotics 

What can you say to mum about the difference in the paracetamol

o   Calpol is brand, paracetamol is generic. Paracetamol will be cheaper as it is generic 

o   Paracetamol more volume ???

o   Finish the entire course for antibiotics , recommend solution version of phenoxymethylpenicillin, 5ml for four time a day for two weeks 

o   Is your child allergic to penicillin 

o   Do not take any other medicines containing paracetamol other than the one prescribed 

o   Can your child take tablets?

o   Take paracetamol when needed but do not exceed 4 times a day 

o   Drink plenty of fluids and get plenty of

o   Provide Difflam spray to improve acceptance, take when needed or 4 sprays every 1.5/ 3 hours  – to soothe sore throat 

o   PRN – when needed. So explain example, paracetamol lasts for 6 hours, if fever comes back again, within the 6 hours you can take again

o   Solution 

What other questions might you want to ask?

o   Any other symptoms?

o   Any further swelling? Is it visible?

o   Is he spitting out the paracetamol also?

o   How often does he take Difflam?

o   In case of misuse, is paracetamol for Teddy?

o   How much water is he drinking exactly? Is he urinating regularly?

§  Indicates amount of fluid in the body. Only goes to toilet once or twice shows he is dehydrated 

o   How is his bowel movement?

§  As not eating properly and also eating antibiotics, antibiotics may kill the probiotics in the intestine causing diarrhoea 

o   Any discomfort in the stomach? Gastric possible?

What is the best course of action for this patient and why 

o   Go to the GP or hospital and seek immediate attention

o   Patient should attend A&E or see if GP can refer to CAU equivalent. Infection has got worse and if he is not drinking will need IV antibiotics. Risk of developing sepsis or further complications such as quinsy. Could be that the infection is viral tonsillitis and therefore won’t respond to abx but he still needs some supportive therapy.

Sometimes the symptoms can be more severe and include:

2. Helps exclude differential diagnosis such as measles, mumps, rubella, influenza (if flu season) covid.

3. Course of action: Patient requires antibiotics. Not improving after 3 days therefore not self limiting. As it is an bacterial tonsillitis, it can be treated using  antibiotics.  As a prescribing pharmacist you could consider prescribing these yourself. However, it is a busy pharmacy and you are the only pharmacist on that day and therefore wouldn’t have someone else to screen the prescription- best course of action would be try to ring to refer to GP.