Sore throat and tonsillitis

Also called Tonsillitis, Pharyngitis, Quinsy

Almost always viral and self-limiting. The complication to know is the one that closes the airway.

What it is

Sore throat is one of the commonest reasons people see a GP, and around 8 in 10 cases are viral, meaning antibiotics do nothing.

Clinical scores such as FeverPAIN and Centor exist to identify the minority likely to be bacterial, and pharmacies in England can now assess and treat sore throat directly under Pharmacy First.

The reason this entry matters is the complications, which are rare and serious.

Quinsy, a peritonsillar abscess, causes severe one-sided pain, difficulty opening the mouth, and a muffled hot-potato voice. It needs drainage.

And any sore throat with drooling, difficulty swallowing saliva, a stiff neck, or difficulty breathing is an airway emergency until proved otherwise.

Signs you might notice

Pain on swallowing, red throat, swollen tonsils, sometimes with white spots.

Fever, swollen neck glands, headache.

Cough and runny nose usually mean viral.

Red flags: drooling, unable to swallow saliva, muffled voice, difficulty opening the mouth, neck stiffness, breathing difficulty, or severe one-sided pain.

A sore throat with a widespread rash may be scarlet fever, which does need antibiotics.

Persistent sore throat or hoarseness for more than three weeks in an adult needs assessment for cancer.

How it can affect day-to-day life

Antibiotic prescribing for sore throat remains higher than the evidence supports, and most people recover in a week either way.

In somebody taking carbimazole for an overactive thyroid, or on chemotherapy or other immunosuppressants, a sore throat with fever is different: it can mean a dangerously low white cell count and needs an urgent blood test the same day.

Recurrent tonsillitis affects school and work substantially, and the threshold for tonsillectomy is specific: broadly seven episodes in a year, five a year for two years, or three a year for three years.

Supporting someone well

Treat symptoms: paracetamol or ibuprofen, fluids, and anaesthetic lozenges or sprays.

Do not push for antibiotics for a typical viral sore throat.

Know the airway red flags and act on them immediately.

Ask about an urgent blood count for anybody on carbimazole, chemotherapy or immunosuppressants with a sore throat and fever.

Keep a record of episodes if tonsillitis is recurrent, because the referral criteria are numerical and undocumented episodes do not count.

Get persistent hoarseness or a sore throat lasting over three weeks in an adult assessed.

Where to get help

A pharmacist can assess and treat sore throat in many areas without a GP appointment.

999 or A and E for drooling, difficulty breathing, or inability to swallow saliva.

Same-day GP for sore throat with fever in anybody immunosuppressed or on carbimazole.