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Viral or bacterial — only the bacterial form benefits from antibiotics, and that can be tested.
Also known as: tonsillitis · sore throat · throat infection
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Sore throat with swollen, reddened tonsils, difficulty swallowing and often fever. The decisive question is whether viruses or streptococci are behind it — because only with bacteria does an antibiotic help. There are pointers: fever, white coating on the tonsils, swollen neck nodes and the absence of cough favour bacteria; an accompanying runny nose and cough favour viruses. A rapid test gives certainty. A stubborn special case is glandular fever, which causes weeks of exhaustion. With one-sided, rapidly increasing swelling, inability to swallow or a muffled voice, seek immediate medical help — this can be an abscess. Anyone with weakened defences is not an ordinary case here: on chemotherapy or steroids, after a transplant, with antibody deficiency or strongly reduced neutrophils. The usual considerations do not apply there, and a sore throat should be assessed earlier than otherwise.
Cold often eases better than warm, lozenges or ice keep the throat moist. Anyone who stops drinking because of the pain gets into a circle — then painkillers half an hour before the meal help.
Coating on the tonsils, fever, swollen neck glands and no cough speak for streptococci — then a rapid test settles it. Cough and a runny nose alongside speak against it: then it is viral, and an antibiotic changes nothing.
Tonsils swollen for weeks, large glands and great tiredness fit with it. Important: one particular antibiotic often triggers a rash in this case, and contact sport is to be avoided for some weeks because of the enlarged spleen.
Not by feel but by frequency: about seven infections in one year, five a year over two years or three a year over three years. Below that the benefit usually does not outweigh.
Severe one-sided pain, a muffled voice, a jaw that will not open or a swelling that pushes the uvula to the side: that speaks for an abscess beside the tonsil and belongs looked at the same day.
Most tonsil infections are viral; an antibiotic changes nothing there. With streptococci it shortens the course by about a day — the real reason for prescribing is to avoid rare sequels such as rheumatic fever. The rapid test decides, not how the tonsils look.
Seven to eight out of ten tonsil infections are viral. Untreated it lasts three to seven days. For surgery the guide is: seven episodes in one year, or five a year over two years, or three a year over three years — below that the burden outweighs the benefit. After the operation the wound pain lasts ten to fourteen days, and a secondary bleed is possible during that time, most often around the fifth to seventh day.
Fever above thirty-eight degrees, coating on the tonsils, swollen and tender lymph nodes at the jaw angle — and no cough. The more of these apply, the more likely bacteria are involved.
A sore throat together with a runny nose, cough and hoarseness is almost always viral — there no antibiotic helps, but pain relief and time do.
Severe one-sided pain, a muffled voice, drooling, a jaw that hardly opens: that speaks for an abscess beside the tonsil and belongs looked at the same day.
Very long-lasting sore throat, thick coatings, swollen nodes all over the neck, heavy tiredness over weeks and a pressure under the left ribs.
Helps to separate the bacterial from the viral form — but it does not decide alone. The swab and the rapid test are there for that.
With glandular fever the blood count looks typical. That explains why a sore throat lasts for weeks and why a certain antibiotic can trigger a rash with it.
In young people with long-swollen tonsils, large lymph nodes and great tiredness the decisive question — and the reason to avoid contact sport for some weeks.
Fever, sweating and faster breathing clearly raise the need. Drinking enough keeps the mucus thin and the circulation steady — in children and older people it is the most important point of all.
With low levels airway infections occur somewhat more often; correcting a deficiency makes sense, a high single dose during the infection does not act on it.
Needed by the defence cells. For lozenges at the start of a cold there are hints of a slightly shortened duration; at a high dose over months zinc lowers copper.
Antibodies and defence cells are protein. After several days with little appetite it is worth at least keeping the protein up — soup with egg, quark, yoghurt, lentils.
K12 has been studied for recurrent throat infections in children — lozenges over 90 days, with fewer episodes in small trials. It does not act on a bacterial tonsillitis that is running.
Studied as a spray or gargle; the relief is short and gets repeated. A purulent tonsillitis with high fever is a different matter from a scratchy throat.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
A single dose of cortisone eases severe pain on swallowing by some hours — that has been studied. It does not replace an antibiotic where one is needed, and it is not part of routine treatment.
Throat pain that sits at the front of the neck and hurts on turning the head can come from a thyroid inflammation after a viral infection. It is regularly mistaken for tonsillitis — the examination tells them apart.
Swallowing hurts for days; many therefore drink too little. Cool food also eases pain — ice cream is, for once, a sensible measure here and not just a comfort.
Sage as a gargle is the traditional choice; the effect is local and brief.
Traditionally used for throat inflammation; avoid with allergy to bee products.
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AWMF 017-024 · S2k · 2024-03 — in force
Therapie der Tonsillo-Pharyngitis
checked 2026-09