Tonsillitis
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is tonsillitis?
Tonsillitis is inflammation of the tonsils, most often viral and self limiting. Bacterial cases are usually caused by group A Streptococcus. Most episodes settle within a week with pain relief alone. Surgery is reserved for people with frequent, well documented recurrent episodes rather than occasional sore throats.
Causes
- Viral infection including adenovirus and Epstein Barr virus
- Group A Streptococcus bacteria
- Other bacteria less commonly
- Close contact transmission
Symptoms
- Sore throat and pain on swallowing
- Red swollen tonsils
- White or yellow patches on the tonsils
- Fever
- Tender swollen neck lymph nodes
- Bad breath
- Muffled voice
- Ear pain referred from the throat
Risk factors
- School age children and adolescents
- Close contact in schools and households
- Frequent upper respiratory infections
- Exposure to tobacco smoke
Diagnosis
- Throat examination
- FeverPAIN or Centor scoring
- Rapid strep testing or throat swab
- Monospot or EBV serology if glandular fever is suspected
- Assessment for peritonsillar abscess if severely unwell
Treatment
- Analgesia with paracetamol or ibuprofen as the mainstay
- Adequate fluids and rest
- Antibiotics only when bacterial infection is likely
- Avoiding amoxicillin if glandular fever is possible
- Drainage of peritonsillar abscess when present
- Tonsillectomy for frequent documented recurrent tonsillitis
Self care
- Take regular paracetamol or ibuprofen, which is the mainstay
- Drink plenty of cool fluids
- Eat soft foods and avoid anything sharp or acidic
- Gargle with warm salt water if old enough
- Rest until fever settles
- Use throat lozenges for comfort in older children and adults
When to see a doctor
Book an appointment if:
- Symptoms lasting more than a week
- Difficulty swallowing fluids
- Frequent recurrent episodes
- A rash with the sore throat
- Extreme fatigue lasting weeks, suggesting glandular fever
- Symptoms not improving on antibiotics
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Wash hands regularly
- Do not share cups, cutlery or towels
- Avoid close contact with people who have throat infections
- Stay home while feverish
- Consider tonsillectomy only after documented frequent recurrence
Outlook
Most tonsillitis is viral and settles within a week with pain relief alone. Bacterial cases respond quickly to antibiotics. Recurrent tonsillitis often reduces naturally with age. Tonsillectomy reliably reduces episodes for people meeting frequency criteria, though recovery is uncomfortable for one to two weeks.
Common questions
When is tonsillectomy considered?
Usually after frequent well documented episodes, commonly around seven in one year, five per year for two years, or three per year for three years, and when episodes significantly disrupt schooling or work.
What is quinsy?
A peritonsillar abscess, a collection of pus beside the tonsil. It causes severe one sided throat pain, difficulty opening the mouth, drooling and a muffled voice, and needs urgent drainage.
Why avoid amoxicillin in suspected glandular fever?
Giving amoxicillin during Epstein Barr virus infection commonly causes a widespread itchy rash. It is not a true penicillin allergy, but it is unpleasant and confuses future prescribing.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.