Patient information from BMJ

Tonsillitis

Last published:Dec 06, 2021

Tonsillitis is a type of sore throat. It can make you feel very ill for a few days. Both adults and children can get tonsillitis, although it is more common in children.

You can use our information to talk to your doctor and decide which treatments are best for you or your child. 

What is tonsillitis?

Tonsillitis is an infection in the tonsils. Your tonsils are two small mounds on either side of the back of your throat. They can get infected with viruses or bacteria, but most cases of tonsillitis are caused by viruses.

When bacteria do cause tonsillitis, the most common type are called Streptococcus. You may hear a sore throat or tonsillitis caused by these bacteria called strep throat.

What are the symptoms?

Tonsillitis causes a bad sore throat that lasts for several days.

You (or your child) will probably have a fever. You may also:

• have a headache

• not feel like eating

• notice white spots on your tonsils, and

• be able to feel lumps under your jaw and in your neck (these are swollen lymph glands).

You may need a few days off school or work.

If your symptoms (or your child's) are very bad or last longer than three days, you should see your doctor.

What treatments work?

Most people with tonsillitis feel better in about a week.

Taking over-the-counter pain medicines such as paracetamol, aspirin, or ibuprofen should help with your symptoms while you recover. You can give your child versions of paracetamol and ibuprofen that are made for children.

But don't give aspirin to children under 16, as it can cause a rare but serious illness called Reye's syndrome, which leads to swelling in the liver and brain.

For people with severe symptoms, doctors sometimes give medicines called corticosteroids. These are strong anti-inflammatory medicines that help reduce swelling and pain. They can be given either as pills or as an injections. They are not usually given to young children.

Some people find that drinking warm tea with honey or gargling with salt water soothes their pain. Sucking throat lozenges or hard sweets can also help.

But don't give hard sweets or lozenges to young children, because they could choke on them. And don't give honey to children under a year old, as there is a chance they could develop a serious illness called botulism.

Will antibiotics help?

Antibiotics will help only if your tonsillitis is caused by bacteria. Antibiotics do not help with infections caused by viruses.

If your doctor thinks you or your child might have tonsillitis caused by bacteria, you will probably be given a rapid antigen test. This test involves rubbing a cotton swab on the back of your throat to collect a sample of fluid. This sample is then tested for signs of the Streptococcus bacteria.

The test is fast, giving results in minutes, but it isn't completely reliable. If the test is negative for Streptococcus, your doctor may do another test called a throat culture. It can take a day or two to get the results.

Your doctor may give you a prescription for antibiotics while you are waiting for the throat culture results. That way, if the throat culture comes back positive for Streptococcus, you can fill the prescription and start taking the antibiotics straight away.

If your tonsillitis is caused by bacteria, antibiotics can reduce how long you have symptoms for, but only by about a day. Antibiotics may also help reduce the chance that the infection will lead to other problems, such as a sinus infection or ear infection. 

Antibiotics can have side effects, but these are usually mild. They include an upset stomach, diarrhoea, or a rash.

What about surgery to remove the tonsils?

If you or your child gets tonsillitis a lot, you may want to think about having surgery. Some people choose to have surgery to remove their tonsils if tonsillitis has been interfering with their life by making them ill a lot.

The operation is done in hospital and you (or your child) will probably have a general anaesthetic, so you won't be awake during the operation. Most people are able to go home the same day.

If your child has his or her tonsils removed, they may get fewer throat infections in the short term.  

Surgery has some risks. You should discuss these with your doctor. They include:

• heavy bleeding during the operation or afterwards

• an allergic reaction to the anaesthetic

• an infection, and

• swelling in your mouth and throat after the surgery.

What will happen?

Tonsillitis usually clears up on its own within a week.

Sometimes tonsillitis leads to other problems, including ear infections, sinus infections, and a rash (called scarlet fever).

Although rare, it's also possible to get more serious problems after having tonsillitis, such as an abscess in your throat. This can make your throat very sore, and you may have difficulty opening your mouth. Occasionally, this can cause breathing problems. If you get any of these symptoms, you should see your doctor. 

If your tonsillitis is caused by Streptococcus bacteria, you could get rheumatic fever, although this isn't common in developed countries. This causes pain and swelling in your joints, a fever, and pain in your chest.

If you have any questions or concerns, you should contact your doctor.