8
Treatment
Figure 2. Tonsillectomy in Children CPG algorithm
KAS1
Watchful waiting with
documentation of any future
infections or change in
condition
At least 7 in past
year; 5/year for 2
years; or 3/year for
3 years?
Option of Tonsillectomy
Primary Reason for Considering Tonsillectomy
Obstructive Sleep Disordered
Breathing (oSDB)
Recurrent
Throat Infection
KAS5
NO
NO
Each episode
documented in the
medical record?
KAS2
YES
PFAPA, history of
peritonsillar abscess,
or multiple antibiotic
allergy/intolerance?
NO
KAS3
Age under 2 years,
Down syndrome, obesity,
craniofacial abnormality,
neurmuscular disorder, sickle
cell disease, or mucopoly-
saccharidosis
Need for surgery
is uncertain or there
is discordance between
tonsillar size on physical
exam and reported
severity of oSDB?
NO
YES
Does child have
growth retardation,
poor school performance,
enuresis, or behavioral
problems?
KAS4
NO
Decision Against Surgery
YES
YES
KAS6
Meets criteria for
in-patient surgery, age
under 3 years, or severe
OSA?
DO NOT give peri-
operative antibiotics
DO NOT give post-
operative codeine
KAS10
KAS14
Ambulatory Setting
In-patient Setting
NO
YES
KAS12
Follow-up to document
primary or secondary
hemorrhage
KAS15a
Tonsillectomy Candidate
NO
