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Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 5 minutes read

Tonsillitis occurs when a viral or bacterial infection causes the tonsils – immune-fighting glands at the back of the mouth – to become inflamed. You get a sore throat causing pain on swallowing and possibly earache, and you may be able to see or feel that one side of the throat is larger from the outside.

Your tonsils will likely look red, possibly with some white dots (pus) on them. You might have a high temperature and headache and feel generally pretty unwell.

Children and young adults are more likely to suffer tonsilitis. Most infections are viral and therefore don’t respond to antibiotics – they get better on their own after about a week. Viral tonsilitis can often go with general symptoms of a cold, such as a runny or blocked nose and a cough.

Some things make a sore throat or tonsillitis more likely to be bacterial, which may need antibiotics to help your body recover. If you have no symptoms of a cold such as a cough, if you have a fever higher than 38 degrees, swollen lymph nodes in your neck, white spots on a very large tonsil, or symptoms have developed quickly, within 24 hours, this makes a bacterial infection more likely.

When your doctor is deciding whether the cause is viral or bacterial, they will sometimes use evidence-based scores that help to decide the likelihood of bacterial infections. If the cause is likely viral, antibiotics won’t help - the infection will get better on its own.

The majority of tonsillitis cases will improve on their own however it is important to stay hydrated and rest to help your body fight the infection. You can take over-the-counter pain relief to help with any pain and your pharmacist can advise you on this. Your pharmacist can also advise you on lozenges and throat sprays to help with a sore throat.

Doctor’s advice

Is it contagious?

Tonsillitis is contagious. It is caused by a virus or bacteria that can be passed onto other people by close contact or through droplets in the air or on surfaces, so it’s best to stay away from others as much as you can and make sure you wash your hands thoroughly.

Healthwords pharmacists' top tips

There are several treatment options to help alleviate the symptoms of a sore throat and tonsilitis.

A spray can such as Difflam (contains Benzydamine) has anti-inflammatory properties to bring down pain and swelling associated with the sore throat. Other sprays like Ultra Chloraseptic contain a local anaesthetic to numb the throat and ease the pain.

A combination of treatments can boost the effectiveness of over-the-counter medications. Try adding one of these to another:

  • gargle with salt water up to four times per day

  • an anti-inflammatory tablet containing ibuprofen or aspirin can bring down pain and swelling. If tablets are difficult to swallow, Nurofen Meltlets can be a good alternative as they dissolve in the mouth

  • for additional pain relief paracetamol can be added to aspirin or ibuprofen. Again, if tablets are too painful to swallow, a soluble form such as Panadol Extra Soluble may be ideal

  • combination products are also available, such as Covonia throat spray which contains an anaesthetic agent (lidocaine) to numb the pain and an antiseptic (chlorhexidine) to reduce infection

  • medicated lozenges such as Strepsils have anaesthetic and mild antibacterial properties and offer an alternative to throat sprays

Am I fit for work?

You are not fit for work if you have tonsillitis.

When should I see my doctor?

You should see your doctor if your symptoms have not started to improve after four or five days or if you are finding it hard to eat or drink.

A very uncommon but serious complication sometimes linked to tonsillitis is quinsy, which is when an abscess occurs next to one of the tonsils. Signs to watch out for include unbearable throat pain, holding your head very still and keeping your voice very quiet as it hurts too much to talk or swallow.

You may even drool or get bad breath. You can feel quite unwell with a high temperature. If you have these symptoms you will need to seek urgent medical attention via your doctor, by calling 111 or the emergency department if outside of working hours.

The doctor will ask about your medical history and your symptoms. They will take your temperature and some basic health measures such as your heart rate and blood pressure. They will look at the back of your throat to view your tonsils. The doctor may take a throat swab to test any bacteria. If your doctor thinks that this is a bacterial sore throat, you will likely be given a course of antibiotics.

Sometimes severe tonsillitis can be linked to glandular fever. The doctor may do a blood test to check for this if they think it may be the case.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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