Sore Throat & Tonsillitis Treatment

Some uncomplicated acute sore throats and suspected tonsillitis can be assessed online. The clinician will review symptom duration, fever, swallowing difficulty, tonsil appearance where available, cough, neck-gland tenderness, allergies, pregnancy status, medical history and current medicines.

Breathing difficulty, inability to swallow fluids or saliva, drooling, severe dehydration, a muffled voice, marked one-sided swelling, trismus or severe systemic illness requires urgent face-to-face assessment.

No. Most acute sore throats are viral and improve without antibiotics. Antibiotics are considered only when clinical features suggest a higher likelihood of bacterial infection or the person is at increased risk of complications.

Clinical scoring systems such as FeverPAIN or Centor can help estimate the likelihood of streptococcal infection. The clinician also considers symptom severity, duration, medical history and risk of complications.

Acute tonsillitis is inflammation of the tonsils, usually caused by a viral infection but sometimes by bacteria such as group A streptococcus.

Symptoms can include sore throat, painful swallowing, fever, swollen or red tonsils, white exudate or spots on the tonsils and tender glands in the neck.

No. Tonsillar exudate can occur with both viral and bacterial infections. The overall clinical picture matters more than a single finding.

Most acute sore throats improve within about 1 week, whether or not antibiotics are used. Persistent, worsening or recurrent symptoms may need reassessment.

Phenoxymethylpenicillin, also called penicillin V, is the first-choice oral antibiotic in NICE guidance for acute sore throat when antibiotic treatment is indicated.

NICE lists 500 mg four times daily or 1,000 mg twice daily for 5 to 10 days in adults.

NICE notes that 5 days may be enough for symptomatic cure, while a 10-day course may increase the chance of microbiological cure. The prescriber will select the appropriate duration.

It is unsuitable for people with a serious penicillin allergy. Previous allergy reactions and relevant medical history must be reviewed before prescribing.

Possible effects include nausea, diarrhoea and abdominal discomfort. Seek urgent help for signs of a serious allergic reaction such as facial or throat swelling or breathing difficulty.

Clarithromycin is an alternative first-choice antibiotic in NICE guidance for people with penicillin allergy or intolerance who are not pregnant.

NICE lists 250 mg to 500 mg twice daily for 5 days in adults.

Clarithromycin can interact with several medicines and may be unsuitable in some people with heart-rhythm problems or significant liver or kidney disease. A medication and medical-history review is required.

Possible effects include nausea, abdominal discomfort, diarrhoea and altered taste. Seek urgent help for a serious allergic reaction, fainting or severe palpitations.

NICE recommends erythromycin if a macrolide is needed during pregnancy and the benefits of antibiotic treatment outweigh the risks.

Most acute sore throats are viral. Antibiotics provide limited benefit for many patients, can cause side effects and contribute to antimicrobial resistance.

Paracetamol can help pain and fever, and ibuprofen may also be suitable for some people. Follow the product directions and consider your medical conditions and other medicines before use.

Some medicated lozenges containing a local anaesthetic, antiseptic or anti-inflammatory ingredient may provide a small reduction in pain. They do not treat the underlying cause.

Yes. Maintaining hydration is important, particularly if you have fever or painful swallowing.

If an antibiotic is prescribed, symptoms should begin to improve over the next few days. Seek reassessment if symptoms worsen rapidly, remain severe or do not improve as expected.

Take the antibiotic exactly as prescribed and complete the course unless a healthcare professional advises otherwise. Do not save leftover antibiotics for another illness.

Seek reassessment if symptoms worsen significantly, you develop increasing swallowing difficulty, dehydration, marked one-sided throat pain or swelling, breathing difficulty or severe systemic symptoms.

Yes. Recurrent tonsillitis may need GP or ENT assessment, particularly if episodes are frequent, severe or significantly affect daily life.

Persistent symptoms may indicate a viral illness, an alternative diagnosis, a complication or treatment failure. Further clinical assessment is appropriate rather than simply repeating antibiotics.

Urgent assessment is needed for breathing difficulty, inability to swallow fluids or saliva, drooling, severe dehydration, a muffled voice, severe one-sided throat swelling, neck swelling, trismus, severe systemic illness or suspected sepsis.

Quinsy, or peritonsillar abscess, can cause severe one-sided throat pain, a muffled voice, drooling, difficulty opening the mouth and asymmetric swelling. It requires urgent assessment.

Difficulty opening the mouth, known as trismus, can be a sign of a deep throat infection such as quinsy and requires urgent face-to-face assessment.

Breathing difficulty or inability to swallow saliva is an emergency symptom. Seek urgent medical help rather than waiting for online treatment.

Pregnancy and breastfeeding should be disclosed before treatment. Antibiotic selection depends on allergy status and individual clinical factors. NICE prefers erythromycin when a macrolide is required in pregnancy.

Repeat antibiotic courses should not be supplied automatically. Recurrent symptoms need reassessment to confirm the diagnosis and consider whether GP or ENT review is appropriate.

If antibiotic treatment is clinically appropriate, it will be dispensed with directions for use and relevant patient information. Follow the dispensing label and leaflet carefully.