Last reviewed: 30 Sep 2024
Last updated: 30 Apr 2024
Summary
Definition
History and exam
Key diagnostic factors
- pain on swallowing
- fever (>100.5°F [>38°C])
- tonsillar exudate
Full details
Other diagnostic factors
- sudden onset of sore throat
- headache
- abdominal pain
- nausea and vomiting
- presence of cough or runny nose
- tonsillar erythema
- tonsillar enlargement
- enlarged anterior cervical lymph nodes
Full details
Risk factors
- age between 5 and 15 years
- contact with infected people in enclosed spaces (e.g., child care centers, schools, prison)
Full details
Diagnostic tests
1st tests to order
- throat culture
- rapid streptococcal antigen test
Full details
Tests to consider
- serologic testing for streptococci
- WBC count and differential
- heterophile antibodies
- vaginal and cervical, or penile, and rectal cultures
- HIV viral load assay
- lateral cervical view x-ray, exposed for soft tissue
Full details
Treatment algorithm
ACUTE
acute tonsillitis not due to group A beta-hemolytic streptococcal infection
acute tonsillitis due to group A beta-hemolytic streptococcal infection
ONGOING
recurrent episodes of tonsillitis
Contributors
Authors
Christos Georgalas, PhD, DLO, FRCS (ORL-HNS)
Professor of Surgery - Head and Neck
University of Nicosia
Cyprus
Disclosures
CG declares that he has no competing interests.
Eleftherios Margaritis, PhD, MSc, MD
Otolaryngologist - Head and Neck Surgeon
Collaborator in Otolaryngology
ENT Department
Hippokration University Hospital
Athens
Greece
Disclosures
EM declares that he has no competing interests.
Peer reviewers
Itzhak Brook, MD, MSc
Professor of Pediatrics and Medicine
Georgetown University
Washington
DC
Disclosures
IB declares that he has no competing interests.
Chris Del Mar, MB BChir, FRACGP MD, MA, FAFPHM
Dean
Faculty of Health Sciences and Medicine
Bond University
Gold Coast
Queensland
Australia
Disclosures
CDM is an author of a number of references cited in this topic.
Differentials
- Infectious mononucleosis
- Epiglottitis
- Peritonsillar abscess (quinsy)
More DifferentialsGuidelines
- Clinical practice guideline: tonsillectomy in children (update)
- A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update
More GuidelinesPatient information
Sore throat
Tonsillitis
More Patient informationCalculators
Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)
More Calculators- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer