Tonsillitis treatments & medications

Experiencing (or having your child experience) a sore throat, swollen tonsils, and difficulty swallowing can be difficult and frustrating. These symptoms commonly indicate a case of tonsillitis or inflammation of the tonsils. Understanding what tonsillitis is and how to treat it are great first steps in starting to feel better. Let’s take a look at what this condition is and what can be done to treat it.

What is tonsillitis?

Tonsils are the two small lumps of soft tissue at the back of the throat—one on each side. Along with the adenoids, tonsils are part of the immune system, trapping germs that can make you sick. Tonsillitis, also called pharyngitis, is an inflammation of the tonsils.

Tonsillitis is more common in children than adults and may be caused by a virus or bacteria. Common symptoms of tonsillitis may include:

• A sore, scratchy throat that appears suddenly

• Painful swallowing

• Swollen tonsils (they may be red or have white spots)

• Sores or blisters on the throat

• Snoring or sleep apnea

• Bad breath

• Headache

• Loss of appetite

• Fever

• Chills

• Tiredness and weakness

• Swollen lymph nodes around the neck

Viruses are a common cause of tonsillitis, In fact, most cases of tonsillitis (about 70%) are caused by a virus, like the Epstein-Barr virus (mononucleosis), adenovirus, or flu virus. Tonsillitis caused by a virus is treated with comfort measures like taking OTC pain and fever reducers, drinking plenty of fluids, and resting.

Bacteria cause other cases of tonsillitis, often Group A Streptococcus. Bacterial tonsillitis is commonly referred to as strep throat. When tonsillitis is caused by bacteria, it is treated with a course of antibiotics such as a penicillin or another antibiotic. An antibiotic helps to eliminate the infection, as well as prevent serious complications such as scarlet fever, rheumatic fever, and kidney damage. Some people, who get frequent infections—or have a complication called a peritonsillar abscess, will even need outpatient surgery.

How is tonsillitis diagnosed?

Because bacterial tonsillitis can cause serious complications if untreated, it is important to see a healthcare provider if you have symptoms of tonsillitis. The provider can determine if your infection is viral or bacterial. You can see a primary care provider (or pediatrician for a child), an urgent care provider, or an ear, nose, and throat (ENT) doctor, also known as an otolaryngologist.

At the appointment, the healthcare provider will:

• Ask questions about symptoms

• Take a medical history

• Examine the patient, checking the throat, lymph nodes, and ears

• Take a throat swab to check for

  strep throat

A rapid strep test will display results in just a few minutes. If the test comes back positive, the healthcare provider will prescribe a course of antibiotic treatment. If the test is negative, the healthcare provider will usually send a sample to a lab. This is called a throat culture, and test results may take up to a few days. A positive culture indicates a bacterial infection, and an antibiotic will be prescribed. If the culture is negative, the illness is determined to be viral and will not require antibiotics.

Tonsillitis treatment options

Viral infection

Patients with a viral infection will not require antibiotics. The viral infection will go away on its own in a few days. You or your child can take over-the-counter (OTC) medications for throat pain or fever, such as Motrin (ibuprofen) or Tylenol (acetaminophen). Children under 18 years old should not take aspirin due to the risk of Reye’s syndrome.

Bacterial infection

Bacterial tonsillitis requires a course of antibiotics. A 10-day course of penicillin or a penicillin-type antibiotic like amoxicillin or Augmentin is commonly prescribed. However, due to allergies or other individual factors, another antibiotic may be more suitable. Patients with a bacterial infection should always finish the complete course of antibiotics prescribed. This ensures the infection goes away, and does not return. It also helps prevent antibiotic resistance. Additionally, people with a bacterial infection can also take OTC pain or fever medications to reduce symptoms, in addition to antibiotics.

Bacterial tonsillitis medications

A 10-day course of penicillin or a drug in the penicillin class is often prescribed for bacterial tonsillitis. However, another antibiotic may be used due to patient allergies or another individual reason.

Penicillin antibiotics

Penicillin, or another drug in the penicillin class of medications, is generally prescribed for ten days as first-line treatment for bacterial strep infection. Examples include penicillin or amoxicillin. Augmentin (amoxicillin and clavulanate) is a penicillin antibiotic that contains amoxicillin—and also contains clavulanate which is called a beta-lactamase inhibitor. Clavulanate helps prevent the bacteria from destroying amoxicillin. Common side effects of drugs in the penicillin class include stomach problems like nausea, vomiting, diarrhea, and stomach pain—as well as rash, yeast infection, and a black, hairy tongue.

Cephalosporin antibiotics

A cephalosporin antibiotic, such as Keflex (cephalexin), is another popular choice of drug for bacterial tonsillitis. It’s generally prescribed to be taken twice a day for ten days. Cephalosporins are similar in structure and function to penicillin antibiotics. Common side effects include nausea, vomiting, diarrhea, stomach pain, and indigestion.

Macrolide antibiotics

A 5-day course of Zithromax (azithromycin) may be a suitable choice for a patient who is allergic to penicillins and/or cephalosporins. Zithromax is a macrolide antibiotic and is in the same drug class as medications like erythromycin and Biaxin (clarithromycin). Common side effects include nausea, vomiting, diarrhea, stomach pain, indigestion, rash, gas, headache, dizziness, and vaginal yeast infections.

Clindamycin

A 10-day course of Cleocin (clindamycin) is another alternative in penicillin-allergic patients. It’s classified as a lincosamide antibiotic. Common side effects include nausea, vomiting, diarrhea, stomach pain, rash, itching, and jaundice (yellowing of the skin and whites of the eyes).

What is the best medication for bacterial tonsillitis?

The best medication for bacterial tonsillitis depends on various factors. Although penicillin and drugs in the penicillin class (such as amoxicillin) are considered first-line treatments, not every patient can take medication from this drug class due to allergies or other individual factors. If you have bacterial tonsillitis, your healthcare provider will determine the most appropriate medication to treat your infection.

The chart below lists the most popularly prescribed medications for bacterial tonsillitis.

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Best medications for tonsillitis