How many days does tonsillitis usually take to clear?
About a week, whatever the cause. NICE's sore throat guideline NG84 says acute sore throat, including tonsillitis, can last around one week. Most people get better within that time without antibiotics, viral or bacterial. The NHS puts the usual course at three to four days.
- Days one to three: fever, which usually lasts two to three days.
- Days three to four: most people start to feel better.
- A throat that is getting worse rather than better: see a doctor.
- Fever past three days, or returning after settling: see a doctor.
- Beyond a week with no improvement: see a doctor.
The time frames come from the NHS and the French health ministry's portal sante.fr, which adds that more than 80% of cases are viral. Antibiotics, when a doctor decides they are justified, shorten symptoms by about 16 hours on average. They also lower a risk of complications that is already small. After a week with no improvement, book a tonsillitis assessment over video.
What are the symptoms of tonsillitis in adults?
A sore throat, trouble swallowing, a high temperature and red, swollen tonsils are the core symptoms. The NHS adds a cough, headache, nausea, earache and tiredness. Your neck glands may be swollen and painful, and the tonsils may show white patches or pus.
White patches alone do not settle the cause; our post on white spots on the throat covers the other explanations. Earache alongside the sore throat has its own causes, covered in our guide to sore throat with ear pain.
If the throat hurts but the tonsils look normal, start with our sore throat page. When a cough is the main complaint and drags on for weeks, read about walking pneumonia symptoms.
Viral or bacterial tonsillitis: which one do you have?
The three signs that point to bacteria are a fever in the last 24 hours, pus on the tonsils, and no cough or runny nose. Tender glands at the front of the neck and a fast onset add to the picture.
None of them proves strep on its own. Even with four or five FeverPAIN points, bacteria are found in only 62 to 65% of swabs. So roughly a third of people with pus-covered tonsils and a fever have a virus. The viral form is often part of a cold or flu-like illness; our guide to this winter's flu strains covers what is circulating.
| Clue | Viral tonsillitis | Strep (bacterial) tonsillitis | Glandular fever |
|---|---|---|---|
| Onset and course | Often part of a cold or flu-like illness | Fast: from normal to very sore within three days | Sore throat, high temperature, swollen glands and heavy tiredness over weeks |
| Fever | Common; usually settles in two to three days | In the last 24 hours, often over 38°C | High temperature |
| Cough or runny nose | Common | Absent, which scores a point on both FeverPAIN and Centor | Not typical; look for swollen glands in the armpits or groin |
| What you see | Red, swollen tonsils, sometimes with white spots | Severely inflamed tonsils with pus on the surface | A blood test confirms the virus |
Tonsil stones are the fourth look-alike: small white or yellow lumps you can cough or spit out, with bad breath and a feeling that something is stuck. They often fall out on their own, are usually not painful or harmful and need no antibiotic, as our tonsil stones page explains.
Our strep throat page covers the bacterial form in detail. Glandular fever spreads through saliva, so through kissing and shared cups and cutlery. The NHS says you can be infectious for up to seven weeks before symptoms appear and for several months afterwards. Symptoms ease within two to four weeks, and tiredness can last months.
Avoid heavy lifting and sport while you are ill with glandular fever: the NHS lists a ruptured spleen among the complications. Severe stomach pain with glandular fever means 112.
Can you have tonsillitis without a fever?
Yes, and it is then more often viral, or not an infection at all. The FeverPAIN score gives one point for a fever in the last 24 hours. No fever lowers the odds of strep but does not rule it out. Pus, a fast onset, badly inflamed tonsils and no cough still add up to four points.
NICE treats four points the same way whether the fever is there or not. Our post on strep throat without fever goes through that case. A scratchy throat with no fever, bad breath and small white lumps you can cough up points to tonsil stones instead.
What is the FeverPAIN score for tonsillitis?
FeverPAIN is a five-point checklist that tells a doctor how likely strep is and whether an antibiotic is worth taking. It comes from NICE guideline NG84. You score one point for each of five findings, and the total steers the antibiotic decision.
- a fever in the last 24 hours;
- pus on the tonsils;
- a throat that became sore within the last three days (the guideline calls this attending rapidly);
- severely inflamed tonsils;
- no cough or runny nose.
| FeverPAIN score | Chance of strep | What NICE advises |
|---|---|---|
| 0 or 1 | 13 to 18% | No antibiotic |
| 2 or 3 | 34 to 40% | Either no antibiotic or a back-up prescription |
| 4 or 5 | 62 to 65% | An antibiotic straight away, or a back-up prescription |
The back-up is collected only if symptoms have not started to improve after three to five days or get worse quickly. Anyone very unwell overall, with signs of a more serious illness or at high risk of complications, is offered an antibiotic at once, whatever the score.
Centor, the older score, uses four items. They are pus on the tonsils, tender glands at the front of the neck, a history of fever over 38°C and no cough. A Centor score of 3 or 4 carries a 32 to 56% chance of strep. It prompts the same decision as FeverPAIN 4 or 5.
Where can you get a strep test in Europe?
In France a trained pharmacist can swab your throat for strep and, if the test is positive, hand you an antibiotic without a prescription. Elsewhere a strep swab, where one is used at all, is normally a doctor's job. The NICE approach our doctors follow bases the decision on the FeverPAIN score, not a swab.
The test is the TROD angine, a throat swab with a result in minutes, performed by a doctor or a pharmacist. It started on 19 June 2024. Pharmacists who have completed a mandatory training course may dispense an antibiotic without a prescription when the test is positive. The route is open to anyone aged 10 or over.
Three groups are sent to a doctor instead. They are anyone who is pregnant or might be, anyone with a weakened immune system (from HIV or chemotherapy, for example), and anyone the pharmacist cannot assess properly.
The official service-public.gouv.fr guidance, verified 5 February 2026, lists insufficient medical information, including a poor command of French, as an exclusion. So bring a translation app or a French-speaking companion. The Assurance maladie covers 70% of the test's cost for people registered with it. As a visitor, ask what you will pay before the swab.
A negative test points to a virus, which needs no antibiotic.
Do adults need antibiotics for tonsillitis?
Usually not. Our doctors follow NICE NG84: pain control first, an antibiotic only when the FeverPAIN score or the overall picture justifies one. The gain is modest, about 16 hours less illness, against side effects, mainly diarrhoea and nausea. Glandular fever is caused by a virus, so antibiotics do nothing for it.
Pain relief that works
Paracetamol is the first choice for pain and fever, with ibuprofen as the alternative if you prefer it and can take it. Medicated lozenges containing a local anaesthetic, an anti-inflammatory or an antiseptic reduce throat pain by a small amount.
NICE found no evidence that plain non-medicated lozenges, mouthwashes or a local anaesthetic throat spray used alone make any difference. Keep drinking; the NHS adds rest, cool drinks and, for adults, gargling with warm salty water. Our guide to sore throat relief from the pharmacy compares the options.
When our doctors prescribe antibiotics
Our doctors consider an antibiotic straight away, or a back-up prescription, at FeverPAIN 4 or 5 (Centor 3 or 4). At FeverPAIN 2 or 3 they give either no antibiotic or a back-up prescription. NICE's usual first choice is phenoxymethylpenicillin, a penicillin available only on prescription.
The course NICE sets is five to ten days. Five days may be enough for the symptoms to go; ten days may improve the chance of clearing the bacteria. For people allergic to penicillin the guideline's alternative is clarithromycin, which is also prescription-only. If you do start a course, our post on how long antibiotics take to work explains what to expect.
What are the symptoms of quinsy?
Quinsy is an abscess, a pocket of pus between the tonsil and the wall of the throat. It is the one tonsillitis complication that cannot wait. One-sided swelling, drooling, a muffled voice or being unable to swallow fluids are the signs of quinsy, and quinsy means 112.
- swelling on one side of the throat or the roof of the mouth;
- pain far worse on that side, sometimes shooting into that ear;
- drooling, because swallowing has become too painful;
- a muffled voice, which doctors call a hot-potato voice;
- being unable to swallow fluids;
- difficulty opening your mouth.
Do not drive yourself: call 112 or have someone take you to an emergency department. Quinsy is an adult's complication more than a child's. It affects about 30 in every 100,000 people a year and peaks between the ages of 20 and 40. It is generally the last stage of a tonsillitis that has been getting worse.
Treatment is in person: the pus is drained with a needle or a small cut, and antibiotics are given. Admission is likely if you cannot take fluids or the airway is at risk.
When is a tonsillectomy considered in adults?
Tonsil removal is considered in adults after seven bouts in one year, five a year for two years running, or three a year for three years running. Those are the criteria in ENT UK's tonsillectomy commissioning guide (revised September 2016). Each bout has to be a significant, documented episode with a real impact on your life.
The count is not rigid: a quinsy, or episodes that are severe and uncontrolled, can justify referral before the numbers are reached. Work, education and quality of life are weighed alongside them.
ENT UK adds two points. There is no evidence that antibiotics prevent recurrent tonsillitis, and a bout treated without antibiotics still counts as a bout. The NHS describes tonsillectomy as very rare, reserved for severe tonsillitis that keeps coming back.
Is tonsillitis contagious?
Tonsillitis itself is not passed on, but the colds, flu viruses and strep bacteria behind it are, through coughs, sneezes and close contact. Stay home while you have a fever or feel too unwell for normal activities. With a confirmed strep infection the NHS says you can return to work 24 hours after starting antibiotics.
Our calculator works out how long strep throat is contagious and gives you the return date. The longer answer on whether strep throat is contagious is in its own post.
When to see a doctor
See a doctor if your throat is no better after a week or if the pain stops you eating or drinking. Pus on your tonsils with a fever and no cough also needs a doctor. So does a fever lasting more than three days or returning after settling, a rash, or bouts that keep coming back.
Scarlet fever and glandular fever are the two look-alikes a doctor checks for when a sore throat does not follow the usual course. Our guide to finding a pharmacy or doctor over Christmas covers the holiday week. Our guide to urgent care in Europe shows where to go for an in-person check.
Call 112 for any of the following:
- swelling inside the mouth or throat, or a swollen neck or face;
- difficulty breathing, swallowing or speaking;
- drooling, or being unable to swallow fluids or your own saliva;
- difficulty opening your mouth;
- a severe sore throat that is getting worse by the hour;
- severe stomach pain during glandular fever.
Mobi Doctor sees adults only: a child with these signs needs local paediatric care or 112. A child with a sore throat and fever needs a local doctor who can examine them.
What a video doctor can do
Most tonsillitis can be assessed over video. Our doctors ask when it started and whether you have a cough or runny nose. Then they look at your tonsils and the front of your neck on camera, with your phone torch in your mouth. That is usually enough to score FeverPAIN and to spot the one-sided swelling of quinsy.
They explain which pain relief to use and decide whether an antibiotic is justified. They issue a prescription when appropriate, sent to a pharmacy you choose, in any of the twelve countries Mobi Doctor covers.
Licensed, EU-registered doctors are available daily 7am–11pm CET, usually within 15 minutes, over video. They will also tell you plainly when a screen is not enough. That means suspected quinsy and anyone who cannot swallow fluids or is struggling to breathe. It also means anyone who needs a throat swab or a blood test for glandular fever, and children, who go to local paediatric services.
If you cannot tell whether this is a virus or strep, a video consultation helps settle it.
Sources
- NICE: Sore throat (acute): antimicrobial prescribing, NG84 (full guideline PDF, published 26 January 2018, last updated February 2023) (accessed 3 November 2026)
- NHS: Tonsillitis (page last reviewed 8 March 2024) (accessed 3 November 2026)
- NHS: Glandular fever (page last reviewed 20 December 2023) (accessed 3 November 2026)
- NHS: Strep A (page last reviewed 7 January 2026) (accessed 3 November 2026)
- ENT UK / Royal College of Surgeons of England: Commissioning guide: Tonsillectomy (revised September 2016) (accessed 3 November 2026)
- Ministère de la Santé (sante.fr): Angines et cystites : les pharmaciens peuvent délivrer sous certaines conditions des antibiotiques sans ordonnance (published 20 June 2024) (accessed 3 November 2026)
- Service-public.gouv.fr (French Government): In what cases can a pharmacist dispense an antibiotic without a prescription? (F37682, verified 5 February 2026) (accessed 3 November 2026)
- Ministère de la Santé (sante.fr): Angine : définition, diagnostic, traitement, prévention (published 13 March 2025, modified 6 July 2026) (accessed 3 November 2026)
- American Family Physician (peer-reviewed): Galioto NJ. Peritonsillar Abscess. Am Fam Physician 2017;95(8):501-506 (accessed 3 November 2026)
- American Family Physician (peer-reviewed): Tonsil Stones, patient information. Am Fam Physician 2023;107(1):41C (accessed 3 November 2026)
Written by the Mobi Doctor Medical Team. Medical review by Dr Chrysoula Liakou, MD, PhD: pending.
