Tonsillitis

When you or your child has tonsillitis, you might notice:

• A very sore throat and difficulty swallowing.¹
• Red, swollen tonsils, sometimes with white or yellow patches (exudate).¹
• Fever or high temperature.¹
• Swollen, tender glands (lymph nodes) in the neck.¹
• Headache, feeling tired, possibly nausea or vomiting.¹
• Bad breath (“halitosis”).¹
• In more severe cases: very swollen glands, pus-filled spots on tonsils, or a lump in your neck.²

Symptoms often improve in about 3–4 days, but full recovery may take a week or more.⁶

• Viral infections are the most common cause (cold or flu viruses).¹
• Bacterial infections, especially Group A Streptococcus (the bacterium behind “strep throat”), can also cause tonsillitis.¹

It is important to diagnose if the infection (of the throat or tonsils) is caused by a Streptococcus A bacteria as it is highly contagious and is associated with serious complications such as Rheumatic Fever, which can damage the heart valves, and kidney damage (glomerulonephritis).

You should seek medical advice if:

• Sore throat persists longer than a normal cold or progressively worsens.⁶
• You struggle to swallow, drool, or can’t drink due to pain.¹
• You develop very high fever, neck stiffness, or muffled speech (possible abscess).¹
• You get tonsillitis repeatedly, or there are other concerning symptoms

At a clinic or doctor’s office, a clinician may:

• Examine your throat, ears, nose, and neck for amongst other signs, swelling, redness and the presence of white exudates or pus.¹
• May do a blood test such as a full blood count to determine if it is a bacterial or viral infection
• May do specific tests to identify specific infections, e.g. infectious mononucleosis.¹
• May take a throat swab to test for Group A Streptococcus (strep).¹
• In South African primary care, doctors may also use clinical scoring tools (like the Centor or FeverPAIN scores) to help decide if antibiotics are needed². This promotes appropriate use of antibiotics, which reduces the emergence of antibiotic resistant bacteria.

Self-Care / Supportive Measures

Whether viral or bacterial, many cases are managed at home with:

• Plenty of rest¹
• Fluids — cool drinks, warm broth, caffeine-free tea, or cold treats like ice pops to soothe the throat¹
• Gargling with warm salt water (½ teaspoon salt in ~240 ml warm water) if you can spit it out afterward¹
• Keeping the air moist (humidifier or sitting in a steamy bathroom)¹
• Pain relief: paracetamol (acetaminophen) or ibuprofen to ease pain or fever — do not give aspirin to children under 16 (due to risk of Reye’s syndrome)
• Avoiding throat irritants: cigarette smoke, strong cleaning fumes, etc.¹

Medication

• Antibiotics (usually penicillin) are used only if a bacterial infection (like strep) is confirmed or strongly suspected.³
• It’s very important to finish the full course, even if you feel better, to ensure complete elimination  of the bacteria and prevent antibiotic resistance.¹

Surgery

• Tonsillectomy (surgical removal of tonsils) may be recommended only if tonsillitis is severe, recurrent, or causes complications (e.g., abscess, sleep problems).¹
• In South Africa, Mediclinic notes that surgery is now reserved for cases where infection is persistent, interferes with daily life, or causes other health problems.⁴

To lower your risk of getting and spreading tonsillitis:

• Wash hands frequently.¹
• When in public spaces and when in company of infected persons, avoid touching your eyes, nose and mouth, which are portals for contracting organisms
• If you must go into public spaces, e.g. doctor or pharmacy, wear a mask
• Avoid sharing food, drinks, or utensils when someone is sick.¹
• Replace your toothbrush after recovery (especially if it was bacterial tonsillitis), to avoid re-infection.¹
• Stay home when symptomatic and avoid close contact with others.¹

1. Stay hydrated — Select soft, soothing liquids such as warm broth, herbal (caffeine-free) tea with honey, or chilled fruit smoothies.
2. Soft, moist foods — Foods like applesauce, mashed potato, yoghurt, jelly, or soft cooked vegetables are easier to swallow when your throat hurts.
3. Cold treats — Ice pops, ice-cream or chilled drinks can provide comfort and numb the soreness.
4. Avoid irritants — Reduce or avoid acidic, spicy, or very rough/crunchy foods until the throat feels better.
5. Nutritious foods — Even if you don’t feel like eating much, try to get enough protein (e.g., soft beans or lentils), vitamins (fruits, well-cooked veg), and minerals to support recovery and immunity.
6. Good hygiene around food — Use clean utensils, do not share food or drinks during illness, and ensure good hand-washing before eating.

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.