Frimley Guidelines

Management of Acute Tonsillitis in Adults

Key Points

  • History and examination to establish tonsillitis. If tonsils + oropharynx look normal, the patient is not suitable for management within this guideline.

  • In-hospital tonsillitis is managed with IV antibiotics, steroids and analgesia.

  • If there are no other concerns, when patients can swallow tablets, they can be discharged home with antibiotics and analgesia.

  • After initial treatment, refer to ENT if they still cannot swallow or there is a high suspicion of a quinsy.

Version:1.0
Date Issued:19/11/2025
Review Date:01/11/2028
Key words:Tonsillitis, Quinsy

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Abbreviations

IV, POIntravenous, Oral
BPBlood pressure
ED, SAUEmergency Department, Surgical Assessment Unit
TDS, QDSThree time a day, Four times a day
FBC, U&Es, CRP, LFTFull blood count, Urea and electrolytes, C-reactive protein,
Liver Function tests

Recognition and assessment:

  • Establish history of sore throat and odynophagia +/- dysphagia, fever, dysphonia.

  • Use FeverPain score to assess the severity of symptoms and need for antibiotics.

  • Ask about recent exposure to glandular fever

  • Assess size of tonsils, redness or exudate of the tonsils, tender cervical lymphadenopathy and neck movements, any trismus or uvula deviation (concerning for Quinsy – note for assessing the uvula position inspect where the uvula meets the roof of the mouth NOT the base).

  • If suspecting a quinsy, consider direct referral to ENT.

  • They must have clear signs of tonsillitis. If tonsils + oropharynx look normal, consider alternative diagnosis.

  • GP referrals to ENT will be seen by ENT team directly, consider SAU if clinically appropriate.