Tonsillitis Treatment: Home Care, Antibiotics and Surgery

How tonsillitis is managed

Tonsillitis is inflammation of the tonsils, caused by viruses in roughly 70–80% of adults and 60–70% of children, and by bacteria (mostly group A Streptococcus) in the rest. The first step is working out how severe the illness is and whether the pattern suggests strep, because that determines whether antibiotics will help. Whatever the cause, symptom relief is always part of treatment. For causes and symptoms see swollen tonsils and strep throat.

Pain and fever relief

Paracetamol (acetaminophen) and/or ibuprofen at the recommended doses; give children weight-based doses and never aspirin to those under 16.
Taking a painkiller 30 minutes before meals makes eating and drinking easier.
Throat lozenges, sprays or gargles with an anaesthetic or anti-inflammatory ingredient give short-term relief for older children and adults.
A single dose of a corticosteroid can reduce pain and speed recovery in some adults and older children with severe symptoms; this is a prescription decision.
Avoid antibiotics-not-needed shortcuts such as using leftover antibiotics.

Home care that helps

Drink plenty of fluids, cool or warm; ice lollies and cold drinks soothe.
Eat soft foods: yoghurt, soup, mashed potato, scrambled egg, porridge.
Rest and sleep with the head slightly raised.
Gargle with salt water (half a teaspoon in a glass of warm water).
Use a humidifier or inhale steam.
Avoid smoking, spicy, acidic or crunchy foods.
Wash hands and avoid sharing cups, cutlery and towels.

When antibiotics are used

Antibiotics are advised for strep throat confirmed by a test (or highly suspected on clinical scoring), for peritonsillar abscess and for tonsillitis in people at higher risk (for example, immunosuppression or previous rheumatic fever). Penicillin V or amoxicillin for 10 days is typical, with alternatives for allergy. In viral tonsillitis, antibiotics do not help and cause side effects (diarrhoea, rash, thrush), and can contribute to resistance. Amoxicillin should be avoided if infectious mononucleosis (glandular fever) is suspected, since it commonly causes a rash.

How long does it last?

Viral tonsillitis usually improves in 5–7 days. Bacterial tonsillitis improves within 2–3 days of antibiotics, with full recovery in a week or so. Glandular fever can cause severe tonsillitis with exhaustion for several weeks. If the sore throat has not improved after a week or keeps getting worse, see a doctor.

Peritonsillar abscess (quinsy)

A pocket of pus can form beside a tonsil as a complication, usually in teenagers and young adults. Warning signs are severe pain on one side, trouble opening the mouth (trismus), a muffled voice, drooling and a swollen uvula pushed to one side. Treatment involves drainage of the pus by a specialist and antibiotics, often with a short hospital stay. Early diagnosis prevents airway problems.

Tonsillectomy: when is it considered?

The AAO-HNSF guideline for children suggests considering tonsillectomy if there have been at least 7 documented episodes of throat infection in one year, 5 per year for two years or 3 per year for three years, with additional features such as fever, enlarged neck glands, tonsil pus or a positive strep test; and for children with sleep-disordered breathing from enlarged tonsils. In adults it is considered for recurrent infections, quinsy or obstruction. Recovery typically takes 1–2 weeks of sore throat, with a small risk of bleeding.

Watchful waiting is reasonable for many people whose episodes do not meet these criteria, since infections tend to become less frequent with time.

Chronic tonsillitis and tonsil stones

Some people have persistent sore throat, bad breath and tonsil stones (tonsilloliths) with minimal infection. Gargling, gentle irrigation and good oral hygiene help; surgery is considered for troublesome symptoms. A one-sided enlarged tonsil in an adult, particularly in a smoker or heavy drinker, should always be examined by an ENT specialist.

When to see a doctor

Severe sore throat with high fever and no cough.
Symptoms not improving after a week, or worsening.
Difficulty swallowing fluids, breathing or opening the mouth.
Frequent episodes in a year.
One tonsil much larger than the other.
A child with loud snoring, pauses in breathing or daytime sleepiness.

Three common situations

An adult with a mild tonsillitis and a cold: pain relief, fluids and rest; no antibiotics expected.

A teenager with severe, one-sided throat pain and trouble opening the mouth: urgent assessment for quinsy.

A child with 6 episodes of tonsillitis in a year: keep a record of each episode with the doctor and discuss thresholds for ENT referral.

What to eat and drink while your tonsils are sore

Cold and soft foods are usually easiest: ice cream, yoghurt, smoothies, jelly, soups, mashed vegetables and scrambled eggs. Sip fluids steadily through the day and watch for signs of dehydration, such as dark urine or very little urination. Avoid crusty bread, crisps and acidic fruit juices until swallowing becomes comfortable again.

Key points to remember

Treat the symptoms, hydrate and rest. Use antibiotics only when needed, and consider tonsillectomy only for recurrent or complicated cases. Know the warning signs and seek care promptly.

This guide is for general information and does not replace an assessment by your own doctor or ENT specialist.

Questions about tonsillitis treatment

These answers are general information and do not replace an examination or individual medical advice.

What is the best treatment for tonsillitis?

Pain relief, fluids and rest for most; antibiotics if it is bacterial (such as strep throat).

Do I always need antibiotics for tonsillitis?

No. Most tonsillitis is viral and antibiotics do not help.

Which antibiotic is used for tonsillitis?

Penicillin V or amoxicillin for 10 days is typical, with alternatives for penicillin allergy.

How long should I stay home?

Until you are fever-free and, for strep, at least 12–24 hours after starting antibiotics.

When should tonsils be removed?

For frequent well-documented infections, recurrent abscesses or enlarged tonsils causing sleep breathing problems.

Is tonsillitis contagious?

Yes. It spreads via droplets and close contact.

Sources

This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.