Viral tonsillitis is caused by a virus, while bacterial tonsillitis is caused by bacteria, such as group A Streptococcus.
Both can cause swollen tonsils, a sore throat, fever and painful swallowing, so symptoms alone cannot always tell you which type you have. A healthcare professional can assess your symptoms and decide whether a throat swab or other investigation is appropriate.
Throat Specialist is founded by Dr Nick Hamilton who specialises in tonsillitis treatment in London and other chronic conditions relating to the throat, tonsils and voice. To discuss your symptoms, please contact us on secretary@throatspecialist.co.uk or call us on 020 7034 6053
Key takeaways:
- Viral tonsillitis is more common and does not respond to antibiotics.
- Bacterial tonsillitis may require antibiotics, depending on the assessment.
- Most episodes improve within around a week, but severe or worsening symptoms need medical advice.
The main difference between viral and bacterial tonsillitis is the type of infection causing inflammation, although their symptoms can overlap.
| Feature | Viral tonsillitis | Bacterial tonsillitis |
|---|---|---|
| Cause | Viruses, including those associated with colds | Bacteria, including group A Streptococcus |
| Common symptoms | Sore throat, swollen tonsils, cough or runny nose | Sore throat, swollen tonsils, fever and painful swallowing |
| Tonsil appearance | Redness and swelling, sometimes with white patches | Redness and swelling, sometimes with white patches or pus |
| Antibiotics | Do not help treat the viral infection | May be recommended following clinical assessment |
| Usual treatment | Rest, fluids and suitable pain relief | Supportive care, with antibiotics when indicated |
| Recovery | Often improves within about a week | Often improves within about a week, with or without antibiotics |
White patches do not automatically mean an infection is bacterial. Similarly, a fever does not prove that antibiotics are necessary. A clinician may use symptoms and examination findings, alongside a scoring system or testing where appropriate, to guide treatment.
Viral tonsillitis is inflammation of the tonsils caused by a virus, and treatment focuses on relieving symptoms while the body’s immune system clears the infection.
Symptoms can include a sore throat, swollen tonsils, coughing, a runny nose, headache and tiredness. Some people also develop white patches on their tonsils.
Antibiotics do not treat viral infections. Instead, rest, regular fluids and suitable pain relief can help you feel more comfortable. Cool drinks and soft foods may make swallowing easier.
Most acute sore throats and coughs improve within around seven days, according to NICE guidance, although the exact recovery time varies. If your symptoms worsen rapidly or fail to improve, seek medical advice because another diagnosis or a complication may need to be considered.
What is bacterial tonsillitis and how do you treat it?
Bacterial tonsillitis is inflammation of the tonsils caused by bacteria, and treatment may include antibiotics when a clinician considers them necessary.
Group A Streptococcus is one possible cause. Symptoms can include a sore throat, fever, swollen neck glands and painful swallowing. However, these symptoms can also occur with viral infections, so it is not always possible to identify the cause by looking at the tonsils alone.
Your GP may assess your symptoms and use a clinical scoring system to estimate the likelihood of a bacterial infection. A throat swab may sometimes be appropriate.
Antibiotics can treat susceptible bacterial infections, but they are not needed for every case. Follow the prescribed instructions if antibiotics are recommended, and seek further advice if symptoms worsen or fail to improve.
What remedies can help with tonsillitis?
The most helpful remedies for tonsillitis include drinking plenty of fluids, resting, choosing soft foods and using suitable pain relief.
Paracetamol or ibuprofen may help with pain and fever if you can take them safely. Follow the packet instructions and ask a pharmacist if you are unsure which medicine is suitable.
Gargling with warm salt water may soothe discomfort in adults who can do so safely. Avoid smoking and other throat irritants, and rest if you feel unwell.
Do not share drinking glasses or utensils while you are unwell, and wash your hands regularly to help reduce the spread of infection. Seek medical advice if you have difficulty drinking or signs of dehydration.
How do I know if I have chronic tonsillitis?
Chronic or recurrent tonsillitis may be suspected when tonsil inflammation persists or repeated episodes of infection keep returning, but a clinician needs to assess the pattern and severity of your symptoms.
You may experience repeated sore throats, painful swallowing, swollen tonsils, fever or swollen glands in your neck. Persistent discomfort can also have causes other than tonsillitis, so it is important not to assume that every sore throat is a tonsil infection.
Keep a record of your episodes, including their duration, severity, impact on work or daily activities, and any treatments you have received. This information can help your GP assess whether specialist care is appropriate.
If infections repeatedly disrupt your life, read our guide on what to do if I keep getting tonsillitis.
Seek emergency care if you develop severe, rapidly worsening throat pain, difficulty breathing, an inability to swallow saliva or difficulty opening your mouth. These symptoms may indicate a serious complication such as quinsy.
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