How to cure a sore throat

A sore throat is usually due to viral infection and rarely something serious: most sore throats will not be due to COVID-19

understand the signs of tonsillitis
deal with symptoms
get treatment if needed

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What is tonsillitis?

Tonsillitis (commonly misspelled as tonsilitis) is one of the commonest ailments to take you to a GP, so it is important to understand what it is, what to do and what to look out for.

What are tonsils? Everyone has two tonsils which sit on either side at the back of the throat. Tonsils are made of soft glandular tissue and form part of the body’s defence against infections, as part of our immune system. They contain cells which trap and kill bacteria and viruses.

Tonsillitis simply means inflammation of the tonsils. It is very common in children and young people, but can occur at any age. Symptoms typically get worse over 2-3 days, and then gradually resolve within a week. Tonsillitis is usually a self-limiting condition – it gets better without treatment.

Is tonsillitis contagious? Tonsillitis is caused by infection with a virus (most commonly the rhinovirus which causes the common cold) or much more rarely bacteria. The commonest bacterium is group A streptococcus, sometimes referred to as a ‘strep throat’. In the past, serious infections, such as diphtheria and rheumatic fever have been linked with tonsillitis, but fortunately these are now rare due to routine childhood immunisations. Glandular fever is a specific type of throat infection, caused by the Epstein-Barr virus. Tonsillitis is spread by coming into close contact with someone with the infection – when the infected person coughs or sneezes, the virus is contained in the millions of tiny droplets that come out of their nose and mouth. Breathing in these droplets can cause tonsillitis. You can get infected by touching your face after touching a surface where the droplets have landed.

Symptoms and signs of tonsillitis

earache, as the ear and throat share the same nerve supply
high temperature
headache
sickness and tiredness
swollen glands in the neck and under the jaw
laryngitis (croaky or loss of voice), due to inflammation spreading to the voice box
foul-smelling breath
rarely, blisters can also develop at the back of the throat and roof of the mouth, due to infections with other viruses, such as coxsackie or herpes virus.

It is impossible to tell by looking at someone’s throat whether the infection is due to a virus or bacterium. Strep throat symptoms are almost indistinguishable from viral tonsillitis, except the pus on the tonsils is more market and the severity of the illness in general is worse. Antibiotics are only helpful in bacterial infections. Viral infections tend to be milder and are often associated with the common cold.

When to contact a doctor

if the sore throat is severe and persists for several days
there is difficulty swallowing fluids
a high temperature
vomiting

Available treatments

A doctor can assess whether antibiotics are needed. Antibiotics will not help a viral infection, but may be recommended for severe bacterial infections. If tonsillitis is mild, you may not need any treatment at all.

Throat lozenges, gargles and sprays that you can buy over-the-counter can help soothe the throat, and ease swallowing.

Have plenty to drink – it is tempting not to drink very much if it is painful to swallow, but this may mean you become short of fluid, especially if you have a fever. Dehydration will make you feel much worse. Have adequate rest, and stay in a warm environment.

Simple pain killers such as paracetamol or ibuprofen will help ease the pain and bring the temperature down. An alternative is to gargle and swallow soluble aspirin. Take the medication at regular intervals as recommended on the packet. Paracetamol is preferred in children, but in adults some evidence suggests ibuprofen may be more effective. If the symptoms are very severe they can be taken together.

When might I need an antibiotic? The answer is not often! Most cases of tonsillitis are caused by viruses, and only occasionally by bacteria. Antibiotics kill bacteria but do not kill viruses. Your own defence mechanisms are usually sufficient to clear the infection whether caused by a virus or bacteria. Antibiotics may be recommended

for severe infection
symptoms are not getting any better after a 4-5 days
if you develop an abscess, called a quinsy
if your normal body's defence mechanism is not working properly, such as if you have your spleen removed, or are taking drugs for cancer

The usual antibiotic recommended is penicillin. If allergic to penicillin you may be given an alternative, such as erythromycin. It is important to finish the whole course, or the infection may recur.

What complications may arise?

Usually tonsillitis settles after about a week. The following complications can occasionally occur

quinsy – an abscess forms in one of the infected tonsils, usually associated with increased pain and difficulty swallowing. Admission to hospital for antibiotics via a drip, and drainage of the abscess, is sometimes required
very rarely the infection may spread to cause an abscess in the neck. This will require an operation to drain the abscess
a secondary infection may occur in the ear, sinuses or chest
scarlet fever, where the tonsil infection is associated with a distinctive sandpapery pink-red rash. This usually affects younger children. Antibiotics are usually recommended

When might tonsillectomy be advised? Surgery to remove the tonsils may be recommended if you suffer four or more severe tonsil infections a year for at least two years, and you are losing a lot of time from school or work. In children, a long course of antibiotics may break the cycle of frequent infections, or tonsillitis may simply stop after a few years.

How does tonsillitis differ from glandular fever? Glandular fever can present like acute tonsillitis with sore tonsils, fever, headache and enlarged lymph glands in the neck, but the swelling in the throat and neck is often more pronounced in glandular fever, and the spleen and liver can be enlarged. There may be a faint rash which is made worse with antibiotics. There is often ongoing tiredness which can last several months. Glandular fever is caused by the Epstein-Barr virus. Childhood attacks are usually mild, so most cases are diagnosed in young adults. The virus is passed by close contact and has been known as the ‘kissing disease’. Diagnosis is confirmed by a blood test (Paul-Bunnell or Monospot test). Treatment is the same as for viral tonsillitis and antibiotics should not be taken. If the spleen becomes enlarged, strenuous exercise or contact sports must be avoided as it is vulnerable to rupture if struck.

This page was last updated on 15/03/2020