Sore Throat and Tonsillitis
Usually a virus, the same ones behind colds and flu. Most sore throats are better within a week without antibiotics. Strep throat is the main bacterial cause, and for people at higher risk of rheumatic fever it needs prompt treatment.
The sore throat ladder
Pain relief does most of the work. Antibiotics help a little, mainly for strep throat. Surgery is for frequent, severe tonsillitis.
- Step 1 · Self-careRest, fluids and soothing foodsPlenty of drinks, soft or cold foods, warm salt-water gargles for adults and older children, and no smoke.
- Works
- Comfort care while it runs its course. Without antibiotics, about 1 in 3 people are symptom-free by day 3 and about 8 in 10 by day 7
- Cost
- Free
- How long
- Usually up to a week, sometimes 10 days
- Watch for
- Not able to swallow your own saliva? That’s not a self-care sore throat.
Ice cream counts as medicine here. Within reason.
- Step 2 · PharmacyParacetamol or ibuprofenTaken regularly at the right dose for a few days.
- Works
- Ease pain and fever more than a dummy tablet in trials
- Cost
- About $3–10 a pack
- How long
- A few days
- Watch for
- Ibuprofen: avoid with stomach ulcers, kidney disease or some heart conditions. No aspirin for under 16s.
Boring, cheap, effective. The holy trinity.
- Step 3 · PharmacyMedicated lozenges or throat spraysNumbing or anti-inflammatory lozenges (such as benzocaine or flurbiprofen) and some antiseptic plus anti-inflammatory sprays.
- Works
- Small extra pain relief vs dummy lozenges. Flurbiprofen lozenges caused side effects (such as mouth irritation) in 3–5 in 10 users in trials
- Cost
- About $8–15
- How long
- As needed for a few days
- Watch for
- Not a substitute for proper pain relief. Check age limits on the pack.
A lolly with a job description.
- Step 4 · PrescriptionAntibiotics (usually penicillin) for likely strep throatYour GP scores your symptoms (fever, pus on the tonsils, tender neck glands, no cough) and may take a throat swab.
- Works
- About 51 in 100 symptom-free by day 3, vs 34 in 100 without; overall they shorten the illness by about 16 hours. The benefit is bigger when strep is confirmed
- Cost
- Under the $25 PBS co-payment
- How long
- 5–10 days, as prescribed
- Watch for
- Diarrhoea, rash, thrush. If strep is confirmed, finish the course.
Antibiotics don’t do viruses. Your throat doesn’t care how much you need to be at work.
- Step 5 · PrescriptionA single dose of steroid for severe painSometimes offered for very painful throats, often alongside antibiotics.
- Works
- About twice as many people pain-free at 24 hours, and pain goes about half a day sooner
- Cost
- Under the $25 PBS co-payment
- How long
- One dose
- Watch for
- Not routinely recommended in UK guidelines because safer options exist. Mostly tested in adults.
One tablet, one day sooner. A niche but real option.
- Step 6 · SpecialistEar, nose and throat surgeon (tonsillectomy)For frequent, severe tonsillitis: 7 or more episodes in a year, 5 a year for 2 years, or 3 a year for 3 years.
- Works
- In a UK trial of adults, surgery halved the number of sore-throat days over 2 years, including recovery time
- Cost
- Free in public hospitals (waits apply); private costs vary
- How long
- About 2 weeks of recovery
- Watch for
- Painful recovery. Bleeding afterwards affected up to 1 in 5 adults in the trial, and some needed to return to hospital.
Two rough weeks to swap for two easier years. Do the maths with your surgeon.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Antibiotics for a viral sore throatThey don’t touch viruses and can cause diarrhoea, rashes and resistant bugs.
- Antibiotics “to prevent complications” in healthy adultsAbout 200 people need treatment to prevent one ear infection. Complications are rare. (Different story if you’re at risk of rheumatic fever.)
- Numbing throat sprays without an antisepticNo trials show they help. A lozenge or regular pain relief is a better bet.
What you can do
- Take paracetamol or ibuprofen regularly for the first few days rather than waiting for the pain to peak.
- Keep sipping fluids, even if swallowing hurts. Cold drinks and ice blocks help.
- Gargle warm salt water (half a teaspoon of salt in a glass of water) if you’re old enough to spit it out.
- Stay home while you have a fever, cover coughs, and wash hands.
- Smoking or vaping? Your throat will heal faster without it. See our quit smoking page.
See your GP if
- It isn’t improving after a week, or it’s getting worse
- Fever over 38°C and you feel very unwell, or large, tender lumps in the neck
- You’re Aboriginal or Torres Strait Islander, live in a remote community, or have had rheumatic fever: see a doctor for any sore throat
- You keep getting tonsillitis
- You have a weakened immune system, for example from chemotherapy
Call 000 or your local emergency number for trouble breathing, drooling or being unable to swallow saliva, trouble opening your mouth, a muffled voice with severe pain on one side (possible throat abscess, called quinsy), or a stiff neck with fever or confusion.
Common questions
Is it viral or strep?
You can’t tell for sure by looking. Strep is more likely with fever, pus on the tonsils, tender neck glands and no cough. A cough, runny nose and hoarse voice point to a virus. About 1 in 5 sore throats are caused by strep.
What is tonsillitis?
Infection and swelling of the tonsils at the back of the throat, usually from a virus and sometimes strep. Tonsils look red and swollen, sometimes with white spots, and swallowing hurts.
How is a sore throat diagnosed?
Your GP looks at your throat, feels your neck and asks about fever and cough, often using a simple symptom score. A throat swab can confirm strep, which matters most for people at higher risk of rheumatic fever.
Why didn’t my doctor give me antibiotics?
For most people they make little difference: about 16 hours less illness on average, plus a chance of side effects. Your doctor may suggest pain relief and returning if it isn’t improving.
Why do rheumatic fever and strep matter in Australia?
Untreated strep can trigger rheumatic fever, which can damage heart valves. Aboriginal and Torres Strait Islander children in rural and remote areas are at highest risk, so prompt treatment of sore throats and skin sores matters.
Helpful resources
- Healthdirect: Sore throatPlain-English guide to causes, self-care and warning signs, plus a 24/7 nurse line on 1800 022 222. Free, Australia.
- Healthdirect: Rheumatic feverWho is at higher risk, why sore throats and skin sores need checking, and links to END RHD resources. Free, Australia.
Evidence and more information
- NICE: Sore throat (acute) antimicrobial prescribing (NG84), summary of evidence
- Cochrane PEARLS: Antibiotics for sore throat
- Cochrane (2020): Corticosteroids for sore throat
- Newcastle University: NATTINA tonsillectomy trial (Lancet 2023)
- Healthdirect: Sore throat
- Healthdirect: Rheumatic fever
- NHS: Quinsy
maladywise.com/sore-throat/