Tonsillitis: Symptoms, Causes, Diagnosis and Treatment — What You Need to Know
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD | Last reviewed: October 7, 2026
Quick Answer
Tonsillitis is inflammation of the tonsils, the two oval pads of tissue at the back of the throat, mainly affecting children and teens. [1] Most cases are viral and clear in 7 to 10 days with home care, while bacterial cases need a full course of antibiotics. [2] Get care right away for trouble breathing, extreme trouble swallowing or heavy drooling. [1]
What the research says
Antibiotics help a sore throat only modestly, and most people improve without them. A Cochrane systematic review of 29 trials with 15,337 cases of sore throat found that antibiotics reduced sore throat at day 3 (RR 0.70, 95% CI 0.60–0.80) and acute rheumatic fever within two months (Peto OR 0.36, 95% CI 0.26–0.50), but 82% of people given placebo or no treatment were symptom-free by one week (Spinks et al., Cochrane Database of Systematic Reviews, 2021). [3]
Surgery is reserved for well-documented, frequent episodes. A systematic review of 68 articles with clinical practice recommendations concluded that tonsillectomy is indicated and highly effective after at least 7 adequately treated episodes in the preceding year, at least 5 in each of the preceding 2 years, or at least 3 in each of the preceding 3 years, and that antibiotics belong only where bacterial tonsillitis is highly probable, judged with a scoring system such as Centor (Guntinas-Lichius et al., Frontiers in Surgery, 2023). [4]
When should you see a doctor for tonsillitis, and when is care urgent?
Because tonsillitis mainly affects children, this guidance is written for parents. Getting a diagnosis matters: a quick diagnosis determines whether treatment means rest and fluids at home or a full course of antibiotics. [1]
Get care right away if your child has trouble breathing, extreme trouble swallowing or a lot of drooling. [1]
Situation | Recommended action |
Sore throat with fever | Call your healthcare professional |
Sore throat that doesn’t go away within 24 to 48 hours | Call your healthcare professional |
Painful swallowing or trouble swallowing | Call your healthcare professional |
Extreme weakness, tiredness or fussiness | Call your healthcare professional |
Trouble breathing | Get care right away |
Extreme trouble swallowing | Get care right away |
A lot of drooling | Get care right away |
What Is Tonsillitis?
Tonsillitis is swelling and irritation (inflammation) of the tonsils. [1] The tonsils are two oval-shaped pads of tissue at the back of the throat, with one tonsil on each side. [1]
Their location is the problem: the tonsils are the immune system’s first line of defense against germs and viruses that enter the mouth. That defensive work puts the tonsils at high risk of infection. [1] The tonsils’ immune work slows after puberty, which might explain why adults rarely have tonsillitis. [1]
Tonsillitis happens mainly in children and teens. Infection with a common virus causes most tonsillitis, but bacterial infections also may cause it. [1]
Treatment depends on the cause, which is why getting a quick diagnosis is important. Surgery to remove the tonsils used to be a common treatment; today it is done mainly when tonsillitis happens often, doesn’t respond to other treatments or causes serious complications. [1]
Question | Answer |
What is it? | Inflammation (swelling and irritation) of the two tonsils at the back of the throat |
Who gets it? | Mainly children and teens; bacterial cases are most common in ages 5 to 15; adults are rarely affected |
What causes it? | Usually a common virus; bacteria, especially group A streptococcus (the strep throat bacterium), also can cause it |
How is it treated? | Viral: at-home care only. Bacterial: a full course of antibiotics |
Is surgery still common? | No. It is now reserved for frequent recurrences, treatment-resistant cases or complications |
What Are the Symptoms of Tonsillitis?
Common symptoms of tonsillitis include:
In young children who can’t tell how they feel, symptoms of tonsillitis may include drooling (because of trouble swallowing or painful swallowing), not eating and being fussier than usual. [1]
What Causes Tonsillitis?
Common viruses most often cause tonsillitis, but bacterial infections also can be the cause. The most common bacterium is Streptococcus pyogenes, also called group A streptococcus. This is the bacterium that causes strep throat. Other strains of strep and other bacteria also may cause tonsillitis. [1]
What Are the Risk Factors?
Risk factor | What it means |
Young age | Tonsillitis most often affects children; tonsillitis caused by bacteria is most common in children ages 5 to 15 |
Being around germs | School-age children are in close contact with other children, so they often meet the viruses or bacteria that can cause tonsillitis |
What Are the Complications?
Frequent inflammation of the tonsils from recurring tonsillitis can cause complications of chronic tonsillitis:
Complication | What it is |
Disturbed breathing during sleep | |
Tonsillar cellulitis | Infection that spreads deep into nearby tissue |
Peritonsillar abscess | Infection causing a buildup of pus behind a tonsil |
Strep-related tonsillitis carries a separate warning. Tonsillitis caused by group A streptococcus or another strain of streptococcal bacteria must be treated with antibiotics. [1] If it isn’t treated, or if treatment isn’t finished, the child has a higher risk of rare disorders:
Risk if strep tonsillitis is untreated | What it is |
Rheumatic fever | A serious condition that can affect the heart, joints, nervous system and skin |
Scarlet fever complications | Complications of a streptococcal infection that has a rash as a main symptom |
Poststreptococcal glomerulonephritis | Inflammation of the kidney |
Poststreptococcal reactive arthritis | Inflammation of the joints |
How Can Tonsillitis Be Prevented?
Other people can catch the germs that cause viral and bacterial tonsillitis, so prevention focuses on hygiene habits children can learn. To protect your own child, teach them to wash hands often and well (especially after using the toilet and before eating), to not share food, drinking glasses, water bottles or utensils, and to use a new toothbrush after being diagnosed with tonsillitis. [1] To help children not spread infection to others, keep them home when they are ill, ask a healthcare professional when it’s OK to return to school, and teach them to cough or sneeze into a tissue or into their elbows and to wash hands afterward. [1]
Prevention habit | How it helps |
Wash hands often and well | Removes germs; especially important after the toilet and before eating |
Don’t share food, glasses, bottles or utensils | Cuts a main transmission route between children |
New toothbrush after diagnosis | Avoids re-exposure to germs |
Stay home while ill; ask when to return to school | Protects classmates |
Cough or sneeze into a tissue or elbow; wash hands after | Reduces spread of respiratory germs |
How Is Tonsillitis Diagnosed?
To diagnose tonsillitis, the child’s healthcare professional starts with a physical exam:
Exam step | What the professional does |
Look inside | Uses a lighted instrument to look at the child’s throat, ears and nose |
Check for rash | Checks for scarlatina, a rash that may be linked to strep throat |
Feel the neck | Gently feels the neck to check for swollen glands |
Listen to breathing | Uses a stethoscope to listen to the child’s breathing |
Check the spleen | Checks for an enlarged spleen, which may point to mononucleosis, another condition that affects the tonsils |
Two tests then help identify the cause. With a throat swab, the professional rubs a sterile swab over the back of the child’s throat, and the sample is checked for streptococcal bacteria. [2] Many clinics have a lab that returns results in minutes. A second, better test, the throat culture, takes longer: it is often sent to a lab, with results taking hours to days. [2] If the fast test shows strep, the child likely has a bacterial infection. If the fast test shows no strep, the infection is likely viral, though the professional may wait for the culture to confirm the cause. [2]
A complete blood count (CBC) uses a small blood sample to measure the types of cells in the blood, such as red cells and white cells. Results can show whether an infection is more likely bacterial or viral. A CBC is not often needed to diagnose strep throat, but if the strep test shows no strep, it can help find the cause. [2]
How Is Tonsillitis Treated?
Treatment for tonsillitis can include at-home care, antibiotics if the cause is bacterial and, in some cases, surgery. The cause decides everything: antibiotics won’t help treat a virus, so viral tonsillitis gets at-home care only, and children with viral tonsillitis will likely be better within 7 to 10 days. [2]
At-Home Care (Viral Tonsillitis)
Comfort measure | Details |
Rest | Plenty of sleep |
Fluids | Plenty of water keeps the throat moist and prevents dehydration |
Comforting food and drink | Warm liquids such as broth, caffeine-free tea or warm water with honey can soothe a sore throat; so can cold treats like ice pops |
Warm saltwater gargle | For children who can gargle: 1/2 teaspoon (2.5 milliliters) of table salt in 8 ounces (237 milliliters) of warm water; spit the saltwater out after gargling |
Moist air | A cool-air humidifier removes dry air that worsens a sore throat, or sit with the child in a steamy bathroom for a few minutes |
Drops to suck on | Children older than age 4 can use lozenges to ease a sore throat |
Remove irritants | Keep the home free of cigarette smoke and throat-irritating cleaning products |
Pain and fever | Talk with your healthcare professional about ibuprofen or acetaminophen; low fevers without pain don’t need treatment. Do not give children or teenagers aspirin, which has been linked to Reye’s syndrome, a rare life-threatening condition, in children or teenagers who have the flu or chickenpox. |
Antibiotics (Bacterial Tonsillitis)
If a bacterial infection is the cause, the healthcare professional prescribes an antibiotic. Penicillin taken by mouth for 10 days is the most common antibiotic treatment for tonsillitis caused by group A streptococcus. If the child is allergic to penicillin, another antibiotic can be prescribed. [2]
The child must take the full course of antibiotics as prescribed, even if symptoms go away. Not taking all the medicine may let the infection worsen or spread to other parts of the body. Stopping early also raises the child’s risk of rheumatic fever and serious kidney inflammation. [2]
Surgery (Tonsillectomy)
Surgery to remove the tonsils, called a tonsillectomy, can treat tonsillitis that comes back often, ongoing tonsillitis, or bacterial tonsillitis that doesn’t respond to antibiotic treatment. [2] Recurring tonsillitis is defined as:
Time frame | Definition |
Past year | At least seven episodes in the year before |
Past two years | At least five episodes a year |
Past three years | At least three episodes a year |
A tonsillectomy also may be done if tonsillitis causes complications, such as obstructive sleep apnea (breathing troubles during sleep), trouble breathing, trouble swallowing or an abscess (pus buildup) that doesn’t improve with antibiotic treatment. [2]
The procedure is most often done as an outpatient procedure, meaning the child can go home the day of surgery. [2] A very young child, a child with other medical conditions, or complications during surgery may mean an overnight hospital stay. [2] Complete recovery most often takes 7 to 14 days. [2]
How should you prepare for a tonsillitis appointment?
If your child has a sore throat, trouble swallowing or other symptoms that may mean tonsillitis, you’ll likely visit your family healthcare professional or your child’s healthcare professional. You may be referred to a specialist in ear, nose and throat disorders. [2]
Be ready to answer:
When did the symptoms begin?
What was the fever temperature, if any?
What eases the symptoms (such as over-the-counter pain relievers or warm liquids)?
Has the child been diagnosed with tonsillitis or strep throat before, and when?
Do the symptoms affect sleep?
Has the child been around anyone with strep throat?
Questions to ask include:
How long will test results take?
What is the best course of treatment?
When can my child go back to school or resume other activities?
Conclusion
Tonsillitis is one of childhood’s most common throat problems, and the evidence points to a simple, well-defined path through it. The tonsils do their immune work at the back of the throat, which makes them frequent infection targets, especially in children ages 5 to 15 and in school settings where germs circulate.
The single most important fork in the road is viral versus bacterial. A viral case needs nothing more than comfort care at home (rest, fluids, warm liquids, saltwater gargles) and usually clears within 7 to 10 days. A bacterial case, particularly one involving strep, needs a full 10-day antibiotic course, and finishing every dose protects against rare but serious complications such as rheumatic fever and kidney inflammation. Surgery has been demoted from routine treatment to a carefully defined last resort, used only for frequent recurrences (seven episodes in a year, five per year for two years, or three per year for three years), treatment-resistant infection, or complications like sleep apnea and abscess.
What matters most is paying attention. A sore throat with fever, one that lingers past 24 to 48 hours, or one that makes swallowing painful deserves a call to your healthcare professional. Trouble breathing, extreme swallowing difficulty or heavy drooling in a child are signals to get care right away.
Next Steps
If your child has these symptoms, call your healthcare professional for a prompt diagnosis. If antibiotics are prescribed, mark the calendar and finish the entire course, even when your child feels better days early.
Frequently Asked Questions
What is tonsillitis?
Swelling and irritation (inflammation) of the tonsils, the two oval-shaped pads of tissue at the back of the throat, one on each side.
Who gets tonsillitis?
Mainly children and teens. Bacterial tonsillitis is most common in children ages 5 to 15. Tonsils are the immune system’s first line of defense against germs entering the mouth, which puts them at high infection risk; their immune work slows after puberty, which might explain why adults rarely get it.
What causes tonsillitis?
Common viruses cause most cases. Bacteria also can, most commonly Streptococcus pyogenes (group A streptococcus), the bacterium that causes strep throat. Other strep strains and other bacteria can also cause it.
How do I know if it’s tonsillitis?
Common symptoms include red swollen tonsils, white or yellow coating or patches, sore throat, trouble or pain when swallowing, fever, swollen tender neck glands, a scratchy or muffled voice, bad breath, stomachache, neck pain, stiff neck and headache. Young children who can’t say how they feel may drool, refuse to eat or be fussier than usual.
When should I call the doctor?
Call your healthcare professional if your child has a sore throat with fever, a sore throat lasting more than 24 to 48 hours, painful or difficult swallowing, or extreme weakness, tiredness or fussiness.
When is it an emergency?
Get care right away for trouble breathing, extreme trouble swallowing or a lot of drooling.
Does tonsillitis go away on its own?
Viral tonsillitis usually does. Children with viral tonsillitis will likely be better within 7 to 10 days with at-home care, and antibiotics don’t help a virus. Bacterial tonsillitis needs antibiotics to resolve properly and to prevent complications.
How is tonsillitis diagnosed?
With a physical exam (looking at the throat, ears and nose; checking for a scarlatina rash; feeling the neck; listening to breathing; checking the spleen for possible mononucleosis), plus a throat swab for strep (a rapid in-clinic result or a slower, better throat culture), and sometimes a complete blood count to tell bacterial from viral.
What is a throat culture?
A throat swab sample sent to a lab. It is a better test than the rapid version but takes hours to days instead of minutes. Professionals may wait for it when the rapid test shows no strep.
How is viral tonsillitis treated?
With at-home care only: rest, plenty of fluids, warm liquids (broth, caffeine-free tea, warm water with honey), cold treats like ice pops, warm saltwater gargles (half a teaspoon of salt in 8 ounces of warm water, for children who can gargle), a cool-air humidifier, lozenges for children over 4, and pain and fever relief after consulting your healthcare professional.
Should I give my child aspirin?
No. Do not give children or teenagers aspirin. It has been linked to Reye’s syndrome, a rare life-threatening condition, in children or teenagers with the flu or chickenpox.
What antibiotic treats bacterial tonsillitis?
Penicillin taken by mouth for 10 days is the most common treatment for group A strep tonsillitis. A different antibiotic is prescribed for children who are allergic to penicillin.
What happens if antibiotics aren’t finished?
The infection may worsen or spread to other parts of the body, and the child’s risk of rheumatic fever and serious kidney inflammation goes up. Take the full course even if symptoms disappear.
When is surgery needed?
A tonsillectomy treats tonsillitis that comes back at least seven times in a year, at least five times a year for two years, or at least three times a year for three years. It also treats ongoing tonsillitis, bacterial tonsillitis that doesn’t respond to antibiotics, or complications such as sleep apnea, breathing trouble, swallowing trouble or an abscess not improving with antibiotics.
Is tonsillectomy still common?
No. Surgery used to be a common treatment; now it is done mainly when tonsillitis happens often, doesn’t respond to other treatments or causes serious complications.
What is recovery from tonsillectomy like?
It is most often an outpatient procedure, so the child goes home the same day. Very young children, children with other medical conditions, or complications during surgery may need an overnight stay. Complete recovery most often takes 7 to 14 days.
What complications can tonsillitis cause?
Obstructive sleep apnea (disturbed breathing during sleep), tonsillar cellulitis (infection spreading deep into nearby tissue) and peritonsillar abscess (pus buildup behind a tonsil). Untreated strep tonsillitis also raises the risk of rheumatic fever, scarlet fever complications, kidney inflammation and joint inflammation.
Is tonsillitis contagious?
Other people can catch the germs that cause viral and bacterial tonsillitis, which is why handwashing, not sharing drinks and utensils, staying home when ill, and coughing into tissues or elbows matter.
Can tonsillitis be prevented?
There is no vaccine or guaranteed method, but teaching children to wash hands often (especially after the toilet and before eating), not share food, glasses, bottles or utensils, use a new toothbrush after diagnosis, stay home when ill, and cough or sneeze into a tissue or elbow all reduce spread.
How long does tonsillitis last?
Viral cases usually resolve within 7 to 10 days. Bacterial cases need a full 10-day antibiotic course; untreated strep can persist and raise complication risks.
What should I ask at the appointment?
How long until test results, what the best course of treatment is, and when your child can return to school or resume activities.
Could it be mononucleosis instead?
Possibly. Mononucleosis also affects the tonsils, which is why the exam may include checking whether the spleen is larger than usual.
Related Reading
Throat Culture: How It Tests for Strep, Rapid Test vs Culture and Results explains the throat swab test used to diagnose strep throat.
Sources
Mayo Clinic Staff. Tonsillitis: Symptoms and causes. Mayo Clinic. August 12, 2025. https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-20378479
Mayo Clinic Staff. Tonsillitis: Diagnosis and treatment. Mayo Clinic. August 12, 2025. https://www.mayoclinic.org/diseases-conditions/tonsillitis/diagnosis-treatment/drc-20378483
Spinks A, Glasziou PP, Del Mar CB. Antibiotics for treatment of sore throat in children and adults. Cochrane Database Syst Rev. 2021;12(12):CD000023. PMID: 34881426. DOI: 10.1002/14651858.CD000023.pub5
Guntinas-Lichius O, Geißler K, Mäkitie AA, et al. Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations. Front Surg. 2023;10:1221932. PMID: 37881239. DOI: 10.3389/fsurg.2023.1221932
Medical disclaimer
This information is for educational purposes only and does not constitute medical advice. In children, trouble breathing, extreme trouble swallowing or heavy drooling require immediate medical care. Antibiotics should only be taken when prescribed by a healthcare professional, and the full course must be completed. Always consult a healthcare professional about your child’s individual situation.
Comments