Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Tonsillitis is a sore throat with the volume turned up: swallowing hurts enough to put you off eating, the glands in your neck swell, and the back of the throat looks angry when you shine a torch at it. It's common, mostly viral, and mostly over in a few days, but it's also the throat infection most likely to need antibiotics and the one with a rare complication worth knowing about. Here's how to recognise it, what helps, and when to stop treating it at home.
What does tonsillitis look like?
The tonsils are the two lumps of tissue either side of the back of the throat. In tonsillitis they're red and swollen, sometimes with white spots or a white coating, and the throat around them is inflamed. The symptoms that go with it:
- a sore throat that makes swallowing painful, often worse on one side
- a high temperature of 38°C or more
- swollen, tender glands in the neck, under the angle of the jaw
- headache, earache (the throat and ear share a nerve), tiredness and feeling generally rotten
- bad breath, a hoarse voice, and in children, tummy ache and being off food
White spots are not, on their own, a sign of bacteria; viruses cause them too. What tilts towards a bacterial infection is a high fever, pus on the tonsils, tender neck glands and no cough; a cough and runny nose point to a virus. GPs score exactly those features before deciding on antibiotics.
How long does tonsillitis last?
Symptoms usually settle in three to four days and are gone within a week. If you're not improving after a week, or the pain is getting worse rather than better after day three, see a GP, because that's the pattern of bacterial tonsillitis or an abscess rather than a virus running its course. Recurrent tonsillitis means seven or more episodes in a year, or five a year for two years; that's when a referral to discuss removing the tonsils is considered, and it's less common than it used to be.
Is tonsillitis contagious?
The infection behind it is. Most cases are caused by the same viruses as colds and flu, and a minority by streptococcus bacteria, and all of those spread by coughing, sneezing and shared cups. You're infectious until the symptoms have gone, or, with antibiotics for strep, after 24 hours of taking them. Children can go back to school once they feel well enough and the fever has gone. Wash hands, bin tissues, don't share drinks, and if you're the one who's ill, stay home for the worst couple of days.
How to treat tonsillitis yourself
| What | Why it helps |
|---|---|
| Paracetamol or ibuprofen, taken regularly for the first two days | Brings the fever down and takes the edge off swallowing. Ibuprofen also reduces the swelling. Children's versions by age and weight. |
| Strefen lozenges | Flurbiprofen, an anti-inflammatory that works where it dissolves; the strongest thing a pharmacy sells for a sore throat. Over-12s, one every 3 to 6 hours, five a day at most, for three days. |
| Strepsils or similar antiseptic lozenges | Keep you swallowing, which soothes; the antiseptic adds little against a virus but the comfort is real. |
| Salt-water gargle (adults) | Half a teaspoon of salt in a glass of warm water, gargle and spit, a few times a day. Reduces swelling and clears debris from the tonsils. |
| Cool drinks, ice lollies, soft food | Cold numbs; soft avoids the scraping. Fluids matter most in children who've stopped drinking. |
| Rest | The infection clears faster if you're not pushing through it. |
Everything in the table is in our throat relief collection, and our guide to what kills a sore throat fast compares lozenges and sprays in more detail.
When does tonsillitis need antibiotics?
Only when it's bacterial, and even then not always; many strep infections clear on their own a day or two slower. A GP will usually prescribe if the fever is high, the tonsils have pus, the neck glands are tender, there's no cough, and you're unwell enough for the difference to matter, or if a throat swab or rapid test confirms strep. The usual course is phenoxymethylpenicillin for five to ten days; take the full course even once you feel better. Antibiotics do nothing for the viral majority, which is why a pharmacist can't sell them for a sore throat.
Tonsil stones: the other white spots
If the white bits on your tonsils aren't painful, come and go, and smell terrible when you cough one up, they're probably tonsil stones: small lumps of hardened debris that collect in the tonsils' folds. They're harmless, common, and have nothing to do with infection. A salt-water gargle, good oral hygiene and a gentle swish with a water flosser usually keep them away; prodding them out with cotton buds tends to cause more irritation than it solves. Stones that keep returning and bother you are worth mentioning to a GP or dentist.
Quinsy: the complication to know
Rarely, the infection spreads from the tonsil into the tissue beside it and forms an abscess, called quinsy. The giveaways: pain that's much worse on one side, difficulty opening the mouth, a muffled "hot potato" voice, drooling because swallowing is impossible, and feeling very ill. It needs same-day hospital treatment to drain. Call 999 or go to A&E if someone has severe throat pain with difficulty breathing, swallowing or speaking.
When to see a GP or call 111
See a GP if symptoms haven't improved after a week, keep coming back, or you have a weakened immune system. Call 111 if the pain is so severe you can't eat or drink, you have pus-filled spots on the tonsils, or a child is drowsy, not drinking or passing little urine. Our pharmacist can advise on the best painkiller and lozenge combination, including for children and in pregnancy.
Frequently asked questions
Can adults get tonsillitis?
Yes, though it's most common in children and teenagers. Adult tonsillitis is more often bacterial and tends to hit harder, so the antibiotic question comes up sooner.
Can tonsillitis go away on its own?
Most of the time, within a week. The home measures above shorten the misery, not the infection; antibiotics shorten a bacterial one by about a day and reduce the small risk of complications.
Can you get tonsillitis without tonsils?
Not tonsillitis exactly, but the surrounding throat tissue can still become infected and feel very similar. A tonsillectomy reduces throat infections; it doesn't abolish them.
Is it tonsillitis or glandular fever?
Glandular fever looks like severe tonsillitis that won't lift: a very sore throat, swollen glands all over the neck and armpits, and exhaustion for weeks. It's commonest in teenagers and young adults, and a blood test tells the two apart. Suspect it if "tonsillitis" is into its second week.