Tonsillitis not responding to antibiotics (child)

[Tonsiltrouble]

Just lying awake next to my 5 year old wondering how long I wait before seeking further medical advice and what route.

DS developed tonsillitis on Wednesday and was prescribed Azithromycin as he has a potential issue with amoxicillin. He spent 2 days getting worse on that antibiotic. Was reviewed by GP Friday and switched to cefalexin. He’s now at the point where I would expect to see some improvement but he still has a raging temperature and rigors (fourth night in a row he’s been like this).

So my options are:

1. Wait until Monday and make contact with our GP (might be ok if he doesn’t get any worse in that time)
2. Seek out of hours GP advice (likely to be a waste of time as swab results pending and not clear what else can be done in primary rare)
3. Go to a&e (almost certainly the correct route if he gets worse, unsure if it’s ‘just’ a failure to get better but the only place with alternate treatment options)

I’m usually pretty good at decisions and advice, but am feeling a little overwhelmed by the fact that he just doesn’t seem to be getting noticeably better.

I don’t think at the moment I’m going to do anything in the middle of the night. But I really need him to get better now. It’s heartbreaking that he’s so poorly, when the meds wear off he’s shaking and sobbing.

i would ring 111.
don't wait til morning.
good luck

A&E first thing.
I once had it and antibiotics didn't help- ended up with accesses on my tonsils and couldn't swallow my own saliva I was in so much pain. I wouldn't let it get any worse.
He'll likely need IV antibiotics.

He’s very peaceful next to me right now (albeit incredibly sweaty and snoring) but I think you might be right that a first thing trip to a&e might be the best option.

Bless him, hope he feels better soon x

My main problem is that I have had a septic child with tonsillitis before (a result of 111 refusing to prescribe and a very rapid deterioration) and he doesn’t feel quite like that. But he seems to be in limbo.

I have also had a very bad experience at a&e in the middle of the night with a very rude and dismissive Dr (child ended up being admitted via the GP the next day with a uti)

i wouldn't wait for it to get worse.
nothing to lose by ringing 111.

I'd go with #2, if a swab was taken on wed the result might be back and OOH should be able to access it to advise hope you get help soon whatever you do, I had tonsillitis a few tears back and felt absolutely awful!

Ah I saw your update, make sure to get rest yourself too!

Is the tonsillitis viral or bacterial?

It could be viral tonsilitis. Tonsilitis can be caused by bacteria or virus. But a temperature for so many days would worry me too. Perhaps see how he is after some sleep. I think I'd be considering a&e in your posistion too

Thanks all. Have bitten the bullet and brought him in. It’s a long wait but although he’s brighter this morning he’s still not right and I want to check he’s ok.

I'm glad you went to ED, 111 can't access (swab) results, people don't usually have rigors with a viral sore throat. The hospital will investigate for sepsis & treat as appropriate. You are both in the right place. I hope your LO gets well soon 💐

Well I’ve already been told that there are patients who have been here 7 hours, and also that I probably haven’t given the antibiotics long enough. Which might be true. But I’m out of my depth at home so hopefully won’t be 7 hours, and I’m ok to wait.

The staff may be right about the antibiotics, but it's unfair to ask parents/carers to make that call when your child was not improving in response to a second course of antibiotics, you did the right thing going to ED

His temperature is creeping up again now, so whilst he was quite bright when he came in, they will soon see what I mean.

@Tonsiltrouble

Well I’ve already been told that there are patients who have been here 7 hours, and also that I probably haven’t given the antibiotics long enough. Which might be true. But I’m out of my depth at home so hopefully won’t be 7 hours, and I’m ok to wait.

I'd have thought that if he's not worse this is overkill. Is there not a miu or ooh service you could have gone via without inflicting a minimum of a 7 hours wait when feeling unwell?

@Tonsiltrouble

His temperature is creeping up again now, so whilst he was quite bright when he came in, they will soon see what I mean.

Bit you're going to presumably not give calpol, so he's going to be in unnecessary discomfort waiting?

Friday to Sunday morning isn't a lot of time for the antibiotics to work.

Have nothing to add but just a virtual hand hold. Hope you get seen soon.

@ChoiceMummy don’t be so bloody horrible. Of course he’s having calpol, just that the staff could be forgiven for thinking he’s not that unwell when he arrived, but when those meds wear off he’s very poorly indeed. I have had a child with quinsy (who was also already on antibiotics) so maybe I am a bit trigger happy. But I wouldn’t wish that experience on anyone. I have a lasting distrust of out of hours since then as they really did fail my child.

I suffered really bad with tonsillitis until they finally got removed when I was 19. I know his pain bless him and my mum ended up with me in a&e a number of times due to how poorly it made me. I know people are saying you've not given the antibiotics enough time and understand they have swapped him antibiotics but they should really have still kicked in by now with him having the 2 days of the others first. It may just be the type of antibiotic as I always use to find unless they gave me amoxicillin then they took about a week to kick in and often ended up having to get a second weeks worth. May also be worth asking them to do a blood test to check for glandular fever if the antibiotics aren't working. Fingers crossed you won't be waiting too long! X

Thanks @BabyFeb22 I wouldn’t expect him to be better by now, but usually I would expect to see signs of improvement, even small signs. We have a bed/bay, and the unit is emptying out. So hopefully won’t be too long.

This happened my daughter several times, she’s been so ill it turned to glandular fever and was admitted. GPS antibiotics weren’t strong enough, push for stronger antibiotics at a&e!

@MushroomHunter

This happened my daughter several times, she’s been so ill it turned to glandular fever and was admitted. GPS antibiotics weren’t strong enough, push for stronger antibiotics at a&e!

Glandular fever, or infectious mononucleosis, is caused by the Epstein-Barr virus, antibiotics are not used to treat viral infections, & this viral infection is different to bacterial tonsillitis, sepsis or peritonsillar abscess. Here, it's not about the 'strength' of the antibiotics, it's about using antibiotics that the bacteria causing infection is sensitive to, the throat swab results will give the clinicians this information

@Tonsiltrouble I hope he’s being seen and you get some reassurance and some effective treatment for him. Maybe they can access his lab results? Mention you are worried about sepsis.
Hopefully you will get a decent practitioner who values parental judgement of how unwell their child is and would far rather see 99/100 children who turn out to be okay than miss the 1/100 who isn’t. here is some coffee to keep you going.

Thanks Lowly. We have been seen by a very lovely ED consultant. He agrees that no improvement by now is unusual, and so we are waiting on a bunch of tests, glandular fever being one of them! At no point has anyone made me feel like I’m wasting time, and whilst ooh might have been appropriate at the start of an illness, if you’re into the realms of running tests thats an a&e thing