How to treat tonsillitis

How to treat tonsillitis

Tonsillitis usually gets better on its own after a few days. To help treat the symptoms for yourself or your child you can:

• Take pain relievers such as paracetamol or ibuprofen - do not give aspirin to children under 16 and always read the instructions of any medicines.

• Drink lots of fluids.

• Get plenty of rest.

• Gargle salt water - not suitable for younger children.

A pharmacist can help with tonsillitis and give advice and suggest treatments, including:

• Lozenges.

• Throat sprays.

• Antiseptic solutions.

If the symptoms are more severe then you should see the doctor who may, in some cases, prescribe antibiotics.

If you think you or your child has tonsillitis find out what to do next by clicking here. This will tell you if you need to see a doctor and how to treat it.

The rest of this feature will take a in-depth look at the treatment of tonsillitis as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

In this series of articles centred around tonsillitis, you can read about the causes of tonsillitis, symptoms of tonsillitis, and treatments for tonsillitis - all written by one of our GP experts.

Simple measures to help tonsillitis

There are some simple things that can help the symptoms of tonsillitis:

• Both bacterial and viral tonsillitis get better with time, as the body fights off the infection. Simply waiting for several days is enough in most cases.

• Getting plenty of rest and drinking enough fluids to avoid dehydration can help recovery.

• Gargling with warm salt water can help with the symptoms of a sore throat:

  • Dissolve half a teaspoon of salt in a glass of warm water.

  • Gargle the warm salt water, then spit it out. Don't swallow.

  • This can be repeated as often as needed.

  • This should be avoided in young children as they may accidentally swallow the salt water solution. Drinking large amounts of salty water can cause people to become unwell.

Pain-relieving medication

Pain-relief medicine can help with the pain from tonsillitis, such as:

• Paracetamol (acetaminophen).

• Ibuprofen.

Fever alone isn't harmful, but if it is making people feel uncomfortable and unwell then paracetamol and ibuprofen can help reduce high temperatures..

Stronger pain relief like codeine or co-codamol - which contains codeine and paracetamol together - might occasionally be needed in severe cases of fever. Always check with a doctor before taking codeine products.

Medicated lozenges

Medicated lozenges can provide temporary pain relief from a sore throat. There are several different brands of medicated lozenges - such as Strepsils, Chloralieve, and Hall - which contain local anaesthetics to temporarily numb the mouth, or antiseptics to kill bacteria.

Mouthwashes and sprays

An anti-inflammatory drug called benzydamine is available in mouthwash, spray, and lozenge form (Difflam). This may help to reduce the pain from tonsillitis.

Steroids

Some studies have looked at using one-off doses of steroid medicines, such as dexamethasone, to treat tonsillitis. These can reduce the inflammation in swollen tonsils and may help to reduce pain from tonsillitis. Evidence suggests that they have only a small effect for most people, so aren't usually given for tonsillitis by GPs. However, they are sometimes used in hospital for people with severe cases of tonsillitis.

Antibiotics

Antibiotics can be helpful if tonsillitis is caused by a bacterial infection but not when caused by a viral infection.

Even in bacterial tonsillitis, antibiotics don't have a big benefit for most people, especially those who are otherwise healthy. Antibiotics reduce the length of symptoms by about a day. Antibiotics do reduce the likelihood of developing complications from tonsillitis caused by strep throat (Group A streptococcus), but these are rare.

The following antibiotics may be prescribed by a GP:

• Penicillin - is the preferred antibiotic for tonsillitis, as it reliably treats Group A streptococcus, but doesn't have as much effect on bacteria elsewhere in the body, such as in the gut.

• Amoxicillin - if penicillin is not available.

• Clarithromycin, erythromycin, cefalexin or co-trimoxazole - if there is a penicillin allergy.

Completing the full course of antibiotics is usually advised to ensure that the infection is fully treated.

In cases of severe tonsillitis, intravenous antibiotics - given through a drip - may be used.

Surgery to remove the tonsils

To reduce the number of throat infections, the tonsils can be surgically removed (tonsillectomy). A tonsillectomy is usually performed alongside removal of the adenoids (adenectomy), another pair of lymph nodes which are located at the back of the mouth.

In the early 20th century in the UK and USA, tonsillectomies were a routine operation for most children. It's now recognised that tonsillectomies are only useful for a small number of people and those people who do not get tonsillitis frequently are unlikely to benefit.

In the UK, tonsillectomy is usually offered for people who have had lots of episodes of sore throats:

• Seven or more proven tonsillitis episodes in a year.

• Five or more proven tonsillitis episodes a year for two years.

• More than two episodes of quinsy - a complication of tonsillitis - in a year.

Tonsillectomies can reduce the number of sore throats; for example, studies have shown that children with severe recurrent sore throats have three or four fewer sore throats a year, compared to prior to the tonsillectomy.

Risks of tonsillectomies include:

• A painful throat for about two to three weeks after the operation.

• Around three out of every 100 children will have bleeding from the throat after surgery. This requires re-admission to hospital for treatment, and in rare cases can be serious or even life-threatening.

• There are also some suggestions it might lead to long-term problems, such as an increased risk of lung conditions.

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by Dr Colin Tidy, MRCGP

Can tonsillitis go away without treatment?

Viral and bacterial tonsillitis usually go away on their own as the body's immune system fights off the infection. Healthy people with functioning immune systems are very efficient at getting rid of the infections that cause tonsillitis.

How long does tonsillitis last?

Tonsillitis symptoms usually get better within three to four days. Eight out of every ten children with tonsillitis will feel better within a week without antibiotics - nine out of every ten children who take antibiotics will feel better within a week. Tonsillitis symptoms can sometimes last several weeks in particularly bad cases. Rarely, some people get repeated bouts of tonsillitis (recurrent tonsillitis) or tonsil infections that remain for long periods of time (chronic tonsillitis).

Complications of tonsillitis

Most people with tonsillitis get better without any serious complications.

Complications of bacterial tonsillitis include:

• Otitis media - a common middle ear infection. This can be treated with antibiotics, although it often gets better on its own without any specific treatment being needed.

• Quinsy or peritonsillar abscess - an abscess (ball of pus) in the back of the throat that needs to be drained in hospital.

• Lemierre's syndrome - a very rare condition where bacteria form an abscess that reaches the veins in the neck, causing bacteria to spread throughout the blood.

Tonsillitis caused by group A streptococcus infection can have the following specific complications:

• Scarlet fever. This is uncommon in the UK but outbreaks do happen. Serious illness as a result of scarlet fever is rare, but antibiotics should be used to prevent it spreading.

• Rheumatic fever. This is now very rare in many countries, including the UK.

• Post-streptococcal glomerulonephritis. This is a rare autoimmune condition that affects the kidneys, starting one to three weeks after the initial infection.

Further reading

• FeverPAIN Clinical Score.

• Sore throat: Should I take antibiotics?; Australian Commission on Safety and Quality in Health Care, 2021.

• Tonsillitis: Do antibiotics make sore throats go away quicker?; Institute for Quality and Efficiency in Health Care (IQWiG). Last updated 2019.