Tonsillitis and Pharyngitis

Tonsillitis and pharyngitis are inflammation of the tonsils and throat, most commonly caused by viral infection, though a proportion of cases — particularly in children — are caused by group A Streptococcus bacteria and require antibiotic treatment.

• Sore throat and pain on swallowing
• Fever
• Red, swollen tonsils, sometimes with white or yellow patches of pus
• Swollen, tender lymph nodes in the neck
• Viral cases often also have cough, runny nose, or hoarseness, which are usually absent in streptococcal infection

• Most commonly caused by viruses.
• A significant proportion, particularly in children aged 5–15, are caused by group A Streptococcus bacteria ("strep throat"), which is important to identify since untreated infection can lead to rheumatic fever.
• Spread through respiratory droplets from an infected person, particularly in close-contact settings such as schools.

• Diagnosed clinically based on symptoms and throat examination.
• Features favouring bacterial (streptococcal) infection include fever, tonsillar exudate (pus), tender front neck lymph nodes, and absence of cough — clinical scoring systems can help estimate the likelihood of streptococcal infection.
• Throat swab and rapid streptococcal testing, where available, can confirm bacterial infection in uncertain cases.

Most cases, especially those with viral features such as cough and runny nose, are managed with supportive care — pain relief with paracetamol, adequate fluids, and rest — as they resolve on their own.

When streptococcal infection is likely or confirmed, a full course of oral penicillin (such as phenoxymethylpenicillin/penicillin V) or amoxicillin is given to reduce symptom duration and, importantly, to prevent the risk of subsequent rheumatic fever.

Patients with difficulty breathing or swallowing, drooling, inability to open the mouth fully, or a severely swollen, one-sided tonsil suggestive of an abscess are referred urgently, as these can indicate a serious complication requiring drainage.

• Practise good hand hygiene and cough etiquette to reduce spread.
• Complete the full course of antibiotics when prescribed for streptococcal throat infection, even once symptoms improve, to reduce the risk of complications.
• Seek prompt treatment for sore throat with fever in children, given the link between untreated streptococcal infection and rheumatic fever.
• Avoid close contact with others while symptomatic to reduce transmission, particularly in school settings.