How long do tonsillitis symptoms typically last?

Tonsillitis Symptom Duration

Tonsillitis symptoms typically last 7-10 days with appropriate treatment, with most patients experiencing symptom improvement within 3-4 days after starting antibiotics for bacterial tonsillitis, while viral tonsillitis resolves on its own within 7-10 days with supportive care. 1

Causes and Symptom Timeline

Tonsillitis can be caused by either viral or bacterial infections:

• Viral tonsillitis (70-95% of cases):

  • Resolves on its own within 7-10 days
  • Supportive care is the mainstay of treatment
  • No antibiotics required 2

• Bacterial tonsillitis (5-30% of cases):

  • Most commonly caused by Group A Streptococcus (GAS)
  • Symptoms begin to improve within 3-4 days of starting appropriate antibiotics
  • Complete resolution typically occurs within 7-10 days with treatment 1, 2

Symptom Management

For symptom relief during the duration of illness:

• Pain management:

  • NSAIDs (e.g., ibuprofen) for pain and inflammation
  • Steroids (e.g., dexamethasone) can help reduce inflammation and pain 3
  • Adequate hydration and soft foods to minimize swallowing discomfort

• Antibiotic treatment (for confirmed bacterial tonsillitis):

  • Penicillin V is the first-line treatment (250 mg three times daily or 500 mg twice daily for 10 days)
  • Full 10-day course is recommended to prevent complications like rheumatic fever 1
  • Symptoms typically improve within 3-4 days of starting antibiotics, but the full course must be completed 1

When to Seek Medical Attention

Patients should seek immediate medical attention if they experience:

• Symptoms lasting longer than 10 days
• Severe difficulty swallowing or breathing
• Inability to take fluids
• High fever (>38°C) that doesn't respond to antipyretics
• Signs of peritonsillar abscess (severe, worsening unilateral pain, voice changes, trismus) 1

Important Considerations

• Diagnosis: Clinical diagnosis is based on symptoms and examination, with Centor criteria helping to determine likelihood of bacterial infection 1
• Testing: Rapid Antigen Detection Test (RADT) is recommended for patients with 3-4 Centor criteria to confirm bacterial infection 1
• Antibiotic stewardship: Antibiotics should only be prescribed for confirmed bacterial tonsillitis to prevent antibiotic resistance 1
• Recurrent tonsillitis: For patients with recurrent episodes (≥7 episodes in the past year, ≥5 episodes per year in the past 2 years, or ≥3 episodes per year in the past 3 years), referral for consideration of tonsillectomy may be appropriate 1, 4

Prevention

To prevent recurrent episodes and spread of infection:

• Good hand hygiene
• Avoiding close contact with infected individuals
• Not sharing utensils or drinks
• Completing the full course of antibiotics if prescribed 1

Remember that most cases of tonsillitis are viral and will resolve within 7-10 days with supportive care alone. Antibiotics should be reserved for confirmed bacterial infections, where they can reduce symptom duration by 1-2 days and prevent rare but serious complications.