Written by Dr Zamiel Hussain, Lead GP and Founder of AccessGP
Sore throats are extremely common over winter, especially after the Christmas period when viruses spread easily through households, workplaces and social gatherings. One of the most common concerns we see as GPs is whether a sore throat is “just viral” or whether it could be tonsillitis that needs antibiotics.
This guide explains what tonsillitis is, how to recognise possible strep throat, when antibiotics help, and when rest and simple treatment are enough.
What is tonsillitis?
Tonsillitis is inflammation of the tonsils, usually caused by infection. It can be caused by:
- Viruses, which are the most common cause
- Bacteria, most often Group A Streptococcus
Viral tonsillitis does not benefit from antibiotics. Bacterial tonsillitis sometimes does, but only when specific criteria are met.
Common symptoms
Tonsillitis often causes:
- Sore throat that is painful when swallowing
- Red or swollen tonsils
- White patches or pus on the tonsils
- Fever
- Swollen glands in the neck
- Headache or ear pain
Children may also develop tummy pain or reduced appetite.
What is strep throat?
Strep throat is a type of bacterial tonsillitis caused by Group A Streptococcus. It is more common in children and young adults, but can affect adults too.
Features that make strep throat more likely include:
- Sudden onset sore throat
- Fever
- Swollen, tender neck glands
- Pus on the tonsils
- No cough
Because symptoms can overlap with viral illness, GPs use structured assessment rather than appearance alone.
How GPs decide if antibiotics are needed
In the UK, GPs commonly use the Centor or FeverPAIN score to guide treatment. This looks at features such as:
- Fever
- Pus on the tonsils
- Rapid onset of symptoms
- Severely inflamed tonsils
- Absence of cough
Most people with low scores do not benefit from antibiotics and recover with supportive care.
Antibiotics may be considered if:
- Symptoms are severe
- FeverPAIN or Centor score is high
- There is a higher risk of complications
- Symptoms are not improving after several days
Which antibiotics are used if needed?
If bacterial tonsillitis is suspected and antibiotics are appropriate, GPs usually prescribe:
- Phenoxymethylpenicillin (Penicillin V) as first line
- Clarithromycin or erythromycin if there is a true penicillin allergy
Antibiotics shorten symptoms slightly and reduce the risk of complications, but they are not always necessary.
When antibiotics are not helpful
Antibiotics do not help if:
- The cause is viral
- Symptoms are mild
- There are no red flag features
Unnecessary antibiotics increase side effects and contribute to antibiotic resistance.
Self care and symptom relief
Most sore throats improve within five to seven days. Helpful measures include:
- Regular fluids
- Paracetamol or ibuprofen for pain and fever
- Rest
- Warm drinks or throat lozenges
Children and adults should stay off school or work if they are unwell with fever.
When to seek urgent help
You should seek urgent medical assessment if there is:
- Difficulty breathing
- Difficulty opening the mouth
- Drooling or inability to swallow fluids
- Severe one sided throat pain
- Neck swelling
- Symptoms worsening rather than improving
These can indicate complications such as quinsy or deeper infection.
How AccessGP can help
At AccessGP, our GPs can assess sore throat and tonsillitis symptoms through same day online appointments. We take a careful history, assess severity, and prescribe antibiotics only when they are clinically appropriate.
We also provide clear safety netting advice and guidance on when face to face or urgent care is needed.
You can also explore our Knowledge Base for trusted explanations of winter infections and related conditions.
Key sources: AccessGP Clinical Knowledge Base; NICE CKS, Acute sore throat; NICE NG84, Acute sore throat antimicrobial prescribing; NHS UK, Sore throat and tonsillitis; Patient.info, Sore throat.