👂 ENTENT / InfectiousStudentInternResident

Acute Pharyngitis & Tonsillitis

Also known as: sore throat · tonsillitis · strep throat

Acute inflammation of the pharynx/tonsils — sore throat, pain on swallowing, fever and tender neck nodes. Most cases are viral; the key is spotting group-A streptococcal ('strep') throat, which benefits from antibiotics and prevents complications.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

All ages, commonest in children and young adults; spread by respiratory droplets.

Red flags — escalate / refer

Severe unilateral pain with trismus and a muffled 'hot-potato' voice (peritonsillar abscess/quinsy), drooling/stridor/breathing difficulty (airway/epiglottitis), or marked systemic illness → urgent ENT/airway assessment.

Work-up / diagnosis

1Estimate the likelihood of streptococcal infection with a clinical score (e.g., Centor/McIsaac — fever, tonsillar exudate, tender anterior nodes, absence of cough).
2Consider a rapid antigen test/throat swab where used; recognise complications such as quinsy.

Management — overview

Most (viral) cases need only supportive care — analgesia/antipyretics, fluids and reassurance.
Give antibiotics (penicillin V/amoxicillin first-line; a macrolide if penicillin-allergic) when streptococcal infection is likely by score/testing — this shortens illness and prevents rheumatic fever and suppurative complications.
Drain a peritonsillar abscess; consider tonsillectomy for recurrent tonsillitis.

In-depthFull dosing & advanced protocol

Drug dosing

Penicillin V / amoxicillin (macrolide if allergic)

Likely streptococcal pharyngitis

Adult dose: Standard course per protocol
Paediatric: Weight-based per protocol
Route: Oral

Caution: AVOID amoxicillin if glandular fever (infectious mononucleosis) is possible — it causes a rash.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Analgesia / antipyretic

Symptom relief (all causes)

Adult dose: Paracetamol/NSAID per protocol
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Score to target antibiotics; treating strep prevents rheumatic fever

Use a clinical score to decide on antibiotics and avoid overuse in viral sore throat.
Treating streptococcal throat prevents acute rheumatic fever and suppurative complications.
Quinsy needs drainage; avoid amoxicillin when glandular fever is possible.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Acute Otitis MediaAn acute middle-ear infection, common in children — ear pain, fever and a bulging, red tympanic membrane. Most are self-limiting; analgesia is the priority.Epistaxis (Nosebleed)Bleeding from the nose — usually anterior (Little's area) and self-limiting, occasionally posterior and serious. First aid controls most; find and treat the cause.Allergic RhinitisIgE-mediated nasal inflammation from allergen exposure — sneezing, itch, watery rhinorrhoea and nasal blockage, often with itchy watery eyes. It is part of the atopic spectrum and strongly linked with asthma.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Penicillin V / amoxicillin (macrolide if allergic)

Analgesia / antipyretic

📈 Score to target antibiotics; treating strep prevents rheumatic fever

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Penicillin V / amoxicillin (macrolide if allergic)

Analgesia / antipyretic

📈 Score to target antibiotics; treating strep prevents rheumatic fever

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Score to target antibiotics; treating strep prevents rheumatic fever

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Score to target antibiotics; treating strep prevents rheumatic fever

References