Sore Throat, Tonsillitis & Peritonsillar Abscess
Assess infection severity, use antibiotics appropriately and recognise abscess or airway risk.
Quick revision ↓ Medical Dictionary
01Uncomplicated sore throat
Most acute sore throats are self-limiting and often viral. Assess pain, fever, hydration, swallowing and general condition, with age-appropriate examination. Clinical tools such as FeverPAIN or Centor can support antibiotic decisions in their intended setting, but do not override red flags. Exudate alone does not prove a bacterial cause or require identical treatment for every patient.
02Support and prescribing
Provide suitable analgesia and hydration advice. Decide on no, delayed or immediate antibiotics according to severity, risk and local guidance. Check allergies and relevant alternative diagnoses, including infectious mononucleosis where the pattern fits. Failure to improve, marked deterioration or inability to maintain fluids needs reassessment rather than simply extending treatment remotely.
03Peritonsillar abscess
Severe unilateral throat pain, trismus, a muffled voice and asymmetric swelling raise concern for a peritonsillar abscess. Uvular displacement may be present but is not required. Arrange urgent ENT assessment for airway, hydration, antimicrobial and drainage decisions. Do not instruct untrained learners to attempt drainage or treat every asymmetric throat as uncomplicated tonsillitis.
04Recurrent disease
Document the frequency, severity and functional effect of recurrent tonsillitis. Surgery decisions use the local eligibility pathway and shared discussion of benefits and risks. Tonsil size alone is not the full indication. Distinguish recurrent infection from sleep-related obstruction and unexplained asymmetry, because these involve different assessment priorities and sometimes different urgency.
05Postoperative bleeding
Fresh bleeding after tonsillectomy is an emergency, including a small apparently settled bleed that may precede further haemorrhage. Assess airway and circulation and obtain urgent ENT and anaesthetic help. Swallowed blood may obscure the amount lost, particularly in children. Do not reassure solely because visible bleeding has paused or the operation occurred several days earlier.
High-Yield Revision
- Clinical scores support but do not replace red-flag assessment.
- Trismus with unilateral severe pain suggests abscess.
- Any fresh post-tonsillectomy bleeding needs emergency assessment.
Common Pitfalls
- Assuming exudate always means bacterial tonsillitis.
- Reassuring a patient after a small postoperative bleed stops.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.