Acute tonsillitis: home care, treatment and red flags

Viruses cause many episodes, while bacteria such as group A streptococcus cause some. Symptoms and the appearance of the throat alone do not always identify the cause, so antibiotics are reserved for situations in which clinical assessment supports a bacterial infection.

The tonsils are pads of immune tissue at the back of the throat. When inflamed, they may look red and enlarged, sometimes with pale spots or a coating. Pain may be felt in the ears even when the ears themselves are healthy because the throat and ears share nerve pathways.

A cough, runny nose, hoarse voice, mouth ulcers, or eye irritation can accompany a viral illness. Fever, tender glands, and the absence of a cough may influence a clinician's assessment for streptococcal infection, but testing or examination may still be needed before choosing treatment.

Drink regularly; cool or warm fluids can be chosen according to comfort. Soft foods, rest, and avoiding smoke may reduce irritation. A pharmacist can advise on suitable pain relief based on age, pregnancy, allergies, stomach or kidney conditions, and other medicines.

Do not share cups, utensils, or toothbrushes, and wash hands after coughing or touching the face. Never use leftover antibiotics. If antibiotics are prescribed, follow the directions and complete the course unless the prescriber advises otherwise; they do not treat viral tonsillitis.

Call emergency services for difficulty breathing, blue or grey lips, severe drowsiness, or inability to swallow saliva. Urgent same-day assessment is needed for drooling, a muffled voice, increasing one-sided throat swelling, difficulty opening the mouth, neck swelling, or a person who appears seriously unwell.

Arrange a routine clinical review if drinking is difficult, urine becomes scant or dark, fever persists, symptoms are worsening rather than settling, or episodes keep returning. A clinician can check hydration and look for a collection of pus beside a tonsil or another source of throat pain.

Ask whether the pattern suggests a viral or bacterial infection, whether a throat swab is useful, and what pain relief is safe with your health conditions. If episodes recur, record their dates, fever, test results, treatments, missed school or work, and any breathing disturbance during sleep.