Do Antibiotics Help Tonsillitis?

Overview

Tonsillitis is a common, mild illness similar to the common cold or the flu. It is often debated whether tonsillitis should be treated with antibiotics, as the dangers of antibiotic resistance due to over-prescription are a hot topic in the medical field today. This article outlines what tonsillitis is, its causes, its treatment, and when antibiotics are needed (and, importantly, when they are not needed).

What Is Tonsillitis?

Tonsillitis refers to an infection, and consequent inflammation, in the palatine tonsils. The palatine tonsils (what we commonly call tonsils) are two easily seen bundles of tissue that sit at each side of the back of the throat. It is thought that their function is to stop pathogens (germs and anything that could cause an infection) from getting into the body through the mouth and nose.

Tonsillitis often affects children and teenagers, but adults can also suffer from it. It is not a dangerous disease, but similar to a cold or flu, it can cause a good amount of discomfort and restrict daily activities.

Causes Of Tonsillitis

Tonsillitis is usually caused by a viral infection, but it can also be caused by bacteria. Both types have most of their symptoms in common.

• Viral: viral infections such as the flu (influenza) or common cold can cause tonsillitis. Epstein-Barr virus (also called glandular fever or infectious mononucleosis) may also cause long-lasting tonsillitis.

• Bacterial: bacterial tonsillitis is usually caused by a group of bacteria called group A streptococcus (from which the term strep throat derives). Treating bacterial tonsillitis requires antibiotics.

Group A strep bacteria also cause other illnesses, such as scarlet fever. In addition, bacterial tonsillitis occasionally gives rise to rheumatic fever, a rare complication of strep throat infections that can affect the joints, skin, and the heart.

Symptoms Of Tonsillitis

The main identifiable characteristic of tonsillitis is, as its name suggests, inflamed tonsils. However, a lot of the symptoms of tonsillitis overlap with those of other respiratory infections. These include: 

• Sore throat
• Runny nose
• Difficulty and pain when swallowing
• Coughing
• Headaches 
• Fever over 38ºC
• Fatigue 
• Neck pain and stiffness
• Swollen neck glands (lymph nodes)
• White spots on the tonsils

Symptoms like coughing and a runny nose are more common in viral tonsillitis, while a swollen neck, white spots on the tonsils, and fever often point to bacterial tonsillitis.

Treatments For Tonsillitis

Most cases of tonsillitis are caused by a viral infection, and therefore the symptoms may be managed at home without needing a visit to the doctor. However, bacterial tonsillitis requires, as its name suggests, antibiotics to fight the infection. 

Antibiotics

Antibiotics are a class of drugs that kill bacteria, a type of organism that can cause a range of diseases, such as skin infections, bacterial meningitis, or urinary tract infections (UTIs). The first-ever and most famous antibiotic is penicillin. Its discovery by Alexander Flemming in the 20th century led to a revolution in the treatment of bacterial infections, for which no effective cure had been found yet.

Oral antibiotics (pills) may be prescribed by a doctor for the treatment of bacterial tonsillitis. Patients are asked to take a specific type of antibiotic during a determined period of time. It is very important to complete the full course of the treatment to prevent antibiotic resistance, even if symptoms disappear before finishing the remaining doses.¹

Although effective, taking antibiotics can give rise to some side effects. The part of the body most affected is usually the gastrointestinal system: nausea, indigestion, diarrhea, abdominal pain, or loss of appetite. In addition, certain antibiotics such as penicillin may cause allergic reactions in some individuals. This is why your doctor will ask if you are allergic to any medication when treating respiratory infections. Patients with a penicillin allergy will be prescribed a different antibiotic.

When Do Antibiotics Help With Tonsillitis

Antibiotics fight bacterial infections (not viruses), so they will only fight bacterial tonsillitis. However, most cases of tonsillitis are viral and should not be treated with antibiotics. Unnecessary prescription of this type of medication contributes to a concerning public health problem known as antibiotic resistance. To receive an antibiotic prescription, your doctor may order a throat swab test to confirm the infection is of bacterial origin.

At-Home Treatments

There are several ways in which the symptoms of tonsillitis can be managed at home. As with any other infection, physical as well as mental rest is advised. Other general methods include drinking plenty of water to stay hydrated and taking over-the-counter analgesics such as ibuprofen and paracetamol to manage the pain. Aspirin can also be taken, but it should not be given to children under 16 without medical supervision.

There are also more specific remedies for tonsillitis. These include:

• Throat sprays 
• Taking hot showers or using a humidifier to prevent dryness and irritation in the throat 
• Honey can reduce inflammation and has some antibacterial properties ²
• Gargles with warm salty water
• Lemon
• Lozenges

Surgery

In some circumstances, the palatine tonsils may need to be surgically removed to treat tonsillitis. This is often the case if the infection keeps coming back multiple times a year (recurrent tonsillitis). This operation is called a tonsillectomy.

Tonsillectomies are one of the most common head and neck surgical interventions.³ They are performed by an ear, nose, and throat (ENT) doctor. Usually, a GP will refer you to this specialist if they consider you as a patient who would benefit from the operation. The surgery lasts about half an hour, and recovery time ranges from 7-10 days. The surgery does not hold many risks, but it is common to feel post-operative pain for a few days, and there is a small risk of hemorrhage (bleeding).³  

Sometimes, a less aggressive operation, called a tonsillotomy, will be carried out. The difference between a tonsillectomy and a tonsillotomy is that during the former, the tonsils are completely removed, while the latter only requires a partial removal.⁴

Summary

Tonsillitis is a throat infection that can be caused by either a virus or bacteria. Symptoms are similar to those of the flu or the common cold: fatigue, a sore throat, headaches or a runny nose. Notably, the tonsils look inflamed and white spots may appear. Tonsillitis is treated with antibiotics only when it is caused by a bacterial infection; if the origin is viral, home treatments are sufficient. Indeed, unnecessarily prescribing antibiotics can contribute to antibiotic resistance. Cases of recurring tonsillitis may require the surgical removal of the tonsils (tonsillectomy).