Mon22November1200AM 6

A 26-year-old lady presents with a two day history of sore throat, fever and difficulty swallowing.

On examination, her tonsils are enlarged, swollen and purulent, there is no focal visible abscess. She is commenced on intravenous benzylpenicillin, however her symptoms have not improved over 72 hours. She remains febrile and continues to complain of a sore throat.

Which of the following antibiotics should be added on?

(Please select 1 option)

Gentamicin

Clarithromycin

Doxycycline

Metronidazole Correct

Flucloxacillin

Explanation

Always consider non-streptococcal causes of tonsillitis in patients who do not respond to appropriate antibiotics.

Group A Streptococcus is the most common cause of bacterial sore throat. Other bacterial causative organisms include:

Non-group A Streptococcus (group C or G)

Arcanobacterium haemolyticum

Corynebacterium diphtheriae

Neisseria gonorrhoeae, and

Fusobacterium necrophorum.

In patients who do not respond to penicillin-based antibiotics, always consider the above organisms, and the possibility of a peritonsillar abscess.

Lemierre's disease is a rare condition, most often caused by Fusobacterium necrophorum. The basic pathophysiology of this condition includes development of a peritonsillar abscess, with seeding of bacteria to the jugular vein and subsequent sepsis.

Reference:

Alherabi A. A case of Lemierre syndrome. Ann Saudi Med. 2009;29:58-60.

UpToDate. Evaluation of acute pharyngitis in adults.

Answer Statistics

1

6%

2

26%

3

10%

4

49%

5

11%

Times answered: 296