Patient information · Urgent care and ENT
Sore throat and tonsillitis
how long it lasts, and when it needs more than painkillers
Most sore throats are caused by viruses and get better on their own within a week, whether or not you take antibiotics. Good pain relief, taken regularly, does more for how you feel than anything else. A small number need urgent attention, and those are worth knowing.
Call 999 or go to an emergency department if you
- have difficulty breathing, or are making a noise when breathing in
- cannot swallow your own saliva, or are drooling
- have a muffled or hot-potato voice, or your neck is swollen
- cannot open your mouth properly, or have severe pain on one side only
- are leaning forward to breathe or cannot lie flat
These can indicate a quinsy (an abscess beside the tonsil) or swelling of the airway, both of which need treating urgently. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Contact us the same day if
- you take carbimazole, methotrexate, azathioprine or another medicine that affects the immune system or white cells — a sore throat with fever can be the first sign of a serious drop in white blood cells and needs an urgent blood test
- you are having chemotherapy, or have a weakened immune system for any other reason
- you develop a fine, sandpapery rash and a red, bumpy tongue — this may be scarlet fever, which does need antibiotics
- the sore throat has lasted more than a week and is not improving, or keeps returning
What to expect
Tonsillitis often comes with a temperature, tender glands in the neck, bad breath and white spots on the tonsils. White spots do not mean bacterial infection or that antibiotics are needed — they are just as common with viruses.
What actually helps
Helps
- Paracetamol or ibuprofen taken regularly rather than occasionally — this is the main treatment
- Cool drinks, ice lollies, soft food. Cold soothes better than hot
- Medicated lozenges or throat sprays containing a local anaesthetic
- Gargling warm salty water (adults and older children only)
- Rest, and plenty of fluids even if swallowing hurts
Does not help
- Antibiotics for a viral sore throat — they shorten it by about a day at best, and cause side effects
- Honey and lemon for babies under one year old (never give honey under one)
- Smoking or vaping, which prolongs the inflammation
- Pushing through at work if you have a fever — rest genuinely shortens it
When antibiotics are appropriate
We use a scoring system that weighs up fever, the appearance of the tonsils, tender neck glands and the absence of a cough. Antibiotics are worth it when several of those features are present together, when you are systemically unwell, or when you are at higher risk of complications — not simply because the throat looks red or you have had it for a few days.
If you are prescribed antibiotics, finish the course. Tell us first if you have ever reacted to penicillin.
If you are aged 15 to 25
A sore throat that drags on for more than a week with extreme tiredness, large neck glands and sometimes a swollen abdomen may be glandular fever. It is diagnosed with a blood test. If you have it, avoid contact sport and heavy lifting for at least four weeks — the spleen can enlarge and is vulnerable to injury. Certain antibiotics also cause a dramatic rash in glandular fever, which is another reason to have it confirmed rather than treated blind.
Work, school and spreading it
- There is no fixed exclusion period for an ordinary sore throat — go back when you feel well enough.
- With scarlet fever, stay off school or work until 24 hours after starting antibiotics.
- Wash hands, bin used tissues, and do not share cups, cutlery or towels.
Recurrent tonsillitis
Repeated, well-documented episodes — broadly seven or more in a year, five a year for two years, or three a year for three years — may justify considering tonsillectomy. Keeping a record of each episode and its treatment is what makes that conversation possible, so tell us each time rather than self-treating.
Book an appointment if you need the throat examined, a throat swab or blood test, an assessment for glandular fever, a sick note, or a referral to our ENT team for recurrent tonsillitis. We can see you the same day and take samples on site.
Seen today, not next week
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.