How can I effectively manage a patient with tonsillitis who presents w

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Effective management of a patient with tonsillitis presenting with severe pain and difficulty swallowing includes:

Assessing for any signs of airway compromise or systemic illness that require urgent hospital admission, such as difficulty breathing, inability to swallow saliva or liquids, clinical dehydration, or signs of sepsis. If these are present, arrange urgent hospital admission or 999 ambulance transfer if epiglottitis is suspected .
Providing adequate analgesia with paracetamol and/or ibuprofen to relieve pain and fever .
Advising adequate fluid intake but avoiding hot drinks as they may exacerbate pain .
Considering prescribing antibiotics if the patient is systemically very unwell, has a high FeverPAIN or Centor score, or if symptoms do not improve after 3 days, especially if there is fever over 38.3°C or worsening pain . Phenoxymethylpenicillin is first-line; clarithromycin or erythromycin can be used in penicillin allergy .
Using medicated lozenges containing local anaesthetics or NSAIDs for temporary throat pain relief .
Advising the patient to seek urgent medical advice if symptoms worsen rapidly, do not improve after 3-4 days, or if difficulty swallowing saliva or breathing develops .
Considering referral to an ear, nose, and throat specialist if the patient has severe recurrent tonsillitis or complications such as peritonsillar abscess .

How can I effectively manage a patient with tonsillitis who presents with severe pain and difficulty swallowing?