Is secondary haemorrhage after tonsillectomy in adults an infective condition?

Sir, Thank you for the opportunity to respond to the comments made by David Lowe et al. We are encouraged that they too are of the impression that secondary haemorrhage post-tonsillectomy is unlikely to be infective in origin. We would respond to their various points as follows: Our title raises the key question and describes what we did. A detailed literature search highlighted current standards for objectively measuring systemic infection while also accepting that there is no guaranteed gold standard in this area. Our search indicated Temperature, White cell count (WCC) and C-reactive protein (CRP) as reliable measures. We feel that we provided sufficient discussion concerning CRP and those other factors which influence its level. We did not enter into a detailed discussion regarding the role of antibiotics or other measures as this was not part of our aim in the paper. We did not ‘recommend’ the use of hydrogen peroxide we merely suggested that it’s use ‘may be sufficient’. We would be interested in the evidence to support their own statement that: ‘prophylactic antibiotic administration, steroid administration, anti-pyretic administration, surgical method and indication for tonsillectomyare of course all powerful factors which may significantly influence haemorrhage’. Regarding elevated WCC and CRP, our text states that 26 patients had an elevated CRP. In 17, this was not accompanied by an elevated WCC while in 9 it was. We apologise if this was not made sufficiently clear by our choice of wording. We stand by our methodology, although not perfect, as a cross-sectional analysis of consecutive patients presenting with secondary post-tonsillectomy haemorrhage in whom a range of measures at the time of admission failed to support a diagnosis of systemic infection sufficient to warrant systemic antibiotic therapy.