Orris

Treatment for acute tonsillitis

Reading File
Reading File
Finding Sources
Finding Sources
Searching PubMed

acute tonsillitis AND treatment

Searching the Web

acute sore throat tonsillitis management antibiotics guideline NICE

Reading File
Reading File
Reading Web Page

https://www.nice.org.uk/guidance/ng84/chapter/recommendation…

Most acute tonsillitis is viral and improves within about a week without antibiotics. Treatment is mainly to relieve pain, maintain fluids, and identify the smaller group with likely streptococcal infection or complications.

Home and supportive treatment

  • Paracetamol (acetaminophen) for throat pain or fever.
  • Ibuprofen can also help if safe for you, but avoid it if you have a history of stomach ulcer/bleeding, significant kidney disease, are dehydrated, or have been advised not to take NSAIDs.
  • Drink plenty of fluids. Choose cool or warm drinks and soft foods as tolerated.
  • Warm salt-water gargles can soothe the throat in adults and older children who can gargle safely.
  • Rest. Avoid smoking and alcohol.
Textbooks describe analgesia, hydration, and saline gargles as the main initial care. Antibiotics are not needed for most cases. Bailey and Love's Short Practice of Surgery, p. 807.

When antibiotics may be appropriate

A clinician may use examination, a rapid strep test or throat swab, and a score such as Centor or FeverPAIN to decide. Features favoring group A streptococcal infection include:
  • Fever
  • Pus/exudate on tonsils
  • Tender anterior neck lymph nodes
  • No cough
For confirmed or strongly suspected streptococcal tonsillitis, penicillin V (phenoxymethylpenicillin) is commonly first choice. The exact drug, dose, and duration depend on age, pregnancy, allergies, local resistance patterns, and severity. For adults, the NICE guideline lists penicillin V 500 mg four times daily or 1 g twice daily for 5-10 days; avoid self-starting antibiotics and get a prescription tailored to you. NICE acute sore-throat guidance recommends no antibiotic or a delayed prescription for many lower-risk cases.
Avoid ampicillin or amoxicillin unless a clinician has excluded infectious mononucleosis (glandular fever/EBV), because they can provoke a characteristic rash in EBV infection. Bailey and Love's Short Practice of Surgery, p. 807.

Seek urgent medical care today if there is

  • Trouble breathing, noisy breathing, drooling, or inability to swallow liquids/saliva
  • Severe one-sided throat pain, muffled “hot potato” voice, inability to open the mouth fully, or uvula pushed to one side, which can indicate a peritonsillar abscess (quinsy)
  • Neck swelling/stiffness, marked dehydration, confusion, or rapidly worsening illness
  • A child under 5 with fever who seems seriously unwell
  • No improvement after 3-5 days, or symptoms worsening after initially improving
These signs can indicate abscess or deeper neck infection, which may need urgent drainage and intravenous treatment. NICE guidance specifically flags quinsy, parapharyngeal/retropharyngeal abscess, and severe systemic infection as complications needing urgent assessment.
This is a shared conversation. Sign in to Orris to start your own chat.