Sore Throat: Viral, Strep or Tonsillitis? How to Tell and When You Need Antibiotics

Most sore throats are caused by viruses, get better within about a week, and don’t need antibiotics. A smaller number are caused by streptococcus bacteria (“strep throat”), which is more common in children and teenagers. A few signs help you tell them apart.

Imagine taking leftover antibiotics for a sore throat that was viral all along: no faster recovery, a chance of side effects and more antibiotic resistance. Knowing the signs of strep helps you get the right treatment, and only when you need it.

Signs that point to strep throat

• Sudden sore throat with a fever
• Swollen, tender glands at the front of the neck
• White patches or pus on the tonsils
• No cough (a cough and runny nose point more towards a virus)
• Often in children aged about 5 to 15

Doctors and nurses often use simple scores based on these signs to decide whether to test or treat. A rapid test or throat swab can confirm strep.

What helps any sore throat

• Drink plenty of fluids and eat cool, soft foods
• Paracetamol or ibuprofen for pain
• Adults can gargle with warm salty water
• Lozenges or throat sprays from a pharmacy

Red flags: get urgent help

• Difficulty breathing or noisy breathing
• Drooling or being unable to swallow saliva
• A muffled “hot potato” voice or severe pain on one side (possible abscess)
• A stiff neck, or being very unwell

But don’t I always need antibiotics for tonsillitis?

No. Tonsillitis is often viral, and antibiotics only help when bacteria are the cause. Even with strep, a doctor decides based on the signs, your age and test results. If you are given antibiotics, take the full course.

Sources: NHS, “Sore throat” and “Tonsillitis”; US Centers for Disease Control and Prevention (CDC), “Strep throat”. This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.