Should I use this page, or skip it?
Use this page if the tonsils look red or spotted and you want to know whether a pharmacist, GP or 111 is first. Skip it and call 999 if you cannot breathe, cannot swallow saliva, are drooling, or the mouth or neck is swelling. This page cannot diagnose strep or glandular fever.
A sore throat with a cold is common. A throat that stops you drinking is a different problem.
What is tonsillitis and what does it feel like?
Tonsillitis is infection or inflammation of the tonsils — the two glands at the sides of the back of the throat. It can feel like a bad cold: sore throat, pain on swallowing, fever, headache, tiredness, sometimes earache. More severe cases have swollen neck glands, white patches or pus on the tonsils, and bad breath.
NHS advice is that symptoms usually go within three to four days but can last longer. White patches do not automatically mean antibiotics.
Can I see a pharmacist first?
Yes, for many sore throats. In England, Pharmacy First can assess selected sore throats if you fit the pathway. Eligibility applies — ask rather than assuming. The pharmacist checks for red flags, then advises self-care, supplies treatment if eligible, or sends you on. Tonsillitis is a type of sore throat, not a separate magic diagnosis.
Scotland has NHS Pharmacy First Scotland, Wales a Common Ailments Service, and Northern Ireland Pharmacy First NI. Find a GPhC-registered pharmacy on Pick My Pharmacy.
Do I need antibiotics?
Usually no. Most tonsillitis is viral. NICE guidance on acute sore throat is that antibiotics make little difference for most people. A clinician may still prescribe them if a bacterial infection is likely and you are particularly unwell. Follow the course you are given. Do not share leftover antibiotics.
Paracetamol or ibuprofen can ease pain — follow the pack. Adults may gargle warm salty water. Children should not.
When is it 111 or 999?
Call 999 if you cannot breathe, cannot swallow, are drooling, have swelling in the mouth or throat, or cannot open the mouth — those can be signs of quinsy. Use 111 if swallowing fluids is hard, you feel very unwell with pus on the tonsils, or symptoms are getting worse quickly but you are still breathing.
In England, Scotland and Wales call 111 (NHS 24 in Scotland). In Northern Ireland there is no general 111 — use GP out-of-hours on nidirect. See pharmacy, GP, 111 or A&E if you are stuck on the door.
How can I ease tonsillitis at home?
Rest, drink cool fluids, and try soft foods if swallowing hurts. Paracetamol or ibuprofen can ease pain — follow the pack. Adults may gargle warm salty water; young children should not. A pharmacist can suggest lozenges or sprays. Honey in a warm drink can soothe — not for babies under one.
You do not need a set number of days off once you feel well enough, unless a clinician has given exclusion advice. Recurrent tonsillitis that disrupts school or work belongs with a GP, who can discuss whether referral for tonsil removal is ever appropriate — it is uncommon.
Is tonsillitis in a child more serious?
Children get viral tonsillitis often. Urgent signs are the same as in adults: working hard to breathe, drooling, not swallowing saliva, or a non-blanching rash. For fever in a baby under 3 months, use the children’s fever pathway and 111 or 999 — not a wait-and-see night with throat spray.
White patches do not automatically mean antibiotics. Glandular fever can look similar in teenagers. Recurrent episodes that disrupt life belong with a GP, not another pack of lozenges.
Who should skip this page?
Skip this page if breathing or swallowing saliva is already a problem — that is urgent care, not a long read. It is not a strep test, not a glandular-fever blood test, and not for a baby with fever who needs the children’s fever pathway. Recurrent tonsillitis belongs with a GP, not another pack of lozenges.
Common questions about tonsillitis
- What causes tonsillitis?
- Most tonsillitis is a virus — the same family as colds and flu. Bacteria such as strep can also inflame the tonsils. It spreads through coughs, sneezes and close contact. It is common in children but adults get it too. Because most cases are viral, antibiotics usually do not help.
- Is tonsillitis contagious?
- Tonsillitis itself is not a separate germ, but the infections that cause it spread easily. Stay at home while you have a high temperature or feel too unwell for normal activities. Wash hands and use tissues. You do not need a set number of days off once you feel well enough, unless a clinician has given exclusion advice.
- Do I need antibiotics for tonsillitis?
- Usually no. A GP may prescribe them if a bacterial infection is likely and you are particularly unwell. White spots alone are not a reason. Follow the course you are given if one is prescribed. Do not use leftover antibiotics. Pain relief and fluids are the main treatment for most people.
- Can a pharmacist help with tonsillitis?
- Yes. A pharmacist can suggest pain relief, lozenges or sprays and check for red flags. In England, Pharmacy First can assess some sore throats — eligibility applies, so ask. They will send you to a GP or 111 if you do not fit the pathway or look more unwell. Scotland, Wales and Northern Ireland have their own schemes.
- When are tonsils removed?
- Surgery is uncommon. It is usually only considered if tonsillitis is severe and keeps coming back despite good care. A GP would discuss and refer if it is appropriate. Recurring sore throats that disrupt school or work belong with a GP, not another bottle of lozenges.
- Is tonsillitis in a child more serious?
- Children get viral tonsillitis often. Urgent signs are the same: working hard to breathe, drooling, not swallowing saliva, or a non-blanching rash. For fever in a baby under 3 months, use the children's fever pathway and 111 or 999 — not a wait-and-see night with throat spray.