Objectives To report changes in practice brought about by COVID-19 and the implementation of new guidelines for the management of tonsillitis and peritonsillar abscess (PTA), and to explore factors relating to unscheduled re-presentations for patients discharged from the emergency department (ED). Design Prospective multicentre national audit over 12 weeks from 6th April 2020. Setting UK secondary care ENT departments Participants Adult patients with acute tonsillitis and PTA Main outcome measures Re-presentation within 10 days for patients discharged from the ED. Results 83 centres submitted 765 tonsillitis and 416 PTA cases. 54.4% (n=410) of tonsillitis cases and 45.3% (187/413) of PTA were discharged directly from the ED. 9.6% (39/408) of tonsillitis and 10.3% (19/184) of PTA discharges re-presented within 10 days, compared to 9.7% (33/341) and 10.6% (24/224) for those initially admitted from ED. The subsequent admission rate of those initially discharged from ED was 4.7% for tonsillitis and 3.3% for PTA. IV steroids were given to 67.0% of tonsillitis patients (n=505/754) and 73.6% of PTA (n=304/413). 77.2% of PTA patients underwent drainage during their initial presentation (n=319/413), but there was no significant difference in re-presentation rate in those drained Vs not-drained (10.6% vs 9.5%, n=15/142 vs 4/42, p=0.846). Univariable logistic regression showed no significant predictors of re-presentation within 10 days. Conclusions Management of tonsillitis and PTA was affected during the initial peak of the pandemic, with a shift towards outpatient care. Some patients who may previously have been admitted to hospital may be safely discharged from the ED.