Acute bacterial tonsillitis: care, treatment and warning signs

Typical features include a sudden sore throat, painful swallowing, fever, tender neck glands and red or coated tonsils. Viral illness can cause similar symptoms, so a clinician uses the history, examination and sometimes a throat swab or rapid test to guide treatment.

The tonsils are immune tissue at the back of the throat. When bacteria infect them, inflammation can make swallowing uncomfortable and may produce white patches or pus. Pain can also be felt in the ear even when the ear itself is not infected.

Strep throat is one bacterial cause, but appearance alone does not reliably separate bacterial from viral tonsillitis. Cough, runny nose, hoarseness or mouth ulcers can point toward a viral cause, while the complete symptom pattern helps a clinician decide whether bacterial testing is useful.

Sip fluids regularly and choose cool or soft foods if swallowing hurts. Rest, avoid smoke, and consider a suitable pain or fever medicine after checking the label and your personal medical restrictions. Children and teenagers should not be given aspirin for a viral-type illness.

Arrange a GP assessment when throat pain is marked, fever persists, symptoms are worsening, or drinking is becoming difficult. If an antibiotic is prescribed, take it on schedule and finish it as instructed unless the prescriber advises otherwise. Do not use leftover antibiotics or share them.

Call emergency services for difficulty breathing, noisy breathing, blue or grey lips, severe drowsiness or collapse. Seek urgent in-person care if saliva cannot be swallowed, drooling develops, the voice becomes muffled, the mouth will not open properly, or swelling and pain are much worse on one side. These symptoms can signal airway narrowing or a collection of infection beside a tonsil.

Reduced urination, dizziness, a very dry mouth or inability to drink suggests dehydration and also warrants prompt help.

You might ask whether a throat test would change management, how to use pain relief safely, when you can return to work or school, and what improvement to expect after treatment starts. Mention recent antibiotic use, medication allergies, recurrent episodes and close contact with someone diagnosed with strep throat.