Medically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
When I examine a painful throat, I use a simple scoring system that looks at fever, pus on the tonsils and swollen glands to judge whether a bacterial infection is likely. That lets me avoid antibiotics when they will not help, and prescribe them promptly when they will.
Tonsillitis tends to reach us at its most miserable point: a traveller who has spent the night unable to swallow water, with a fever, an aching jaw and neck glands like marbles. Backpackers sharing dorms and people training hard at Muay Thai camps seem to get it most, often after a run of late nights and little sleep. Many expect antibiotics, but plenty have a viral tonsillitis that antibiotics will not touch, and our job is to tell the two apart and catch complications early.
What tonsillitis is
The tonsils are two pads of lymph tissue at the back of the throat that sample germs entering through the mouth. In tonsillitis they become infected and inflamed: red, swollen and often coated with white or yellow spots of pus. Viruses cause most episodes, including the Epstein-Barr virus behind glandular fever, while group A streptococcus causes a minority. Pus occurs with viruses too, so it is not proof of a bacterial infection on its own. Expect painful swallowing, fever, tender glands under the jaw and a thick voice for about a week. For throat pain from air conditioning, smoke or voice strain, see our broader sore throat treatment guide.
Is it bacterial? FeverPAIN and Centor explained
No single sign separates viral from bacterial tonsillitis, so doctors use validated scores. FeverPAIN, recommended by the UK’s NICE, scores five features:
| Component | Feature | Points |
|---|---|---|
| Fever | Fever in the past 24 hours | 1 |
| P | Purulence: pus on the tonsils | 1 |
| A | Attended rapidly: seen within 3 days of onset | 1 |
| I | Inflamed tonsils: severely red and swollen | 1 |
| N | No cough or runny nose (coryza) | 1 |
NICE links a FeverPAIN score of 0-1 with roughly a 13-18% chance of strep, where no antibiotic is advised; 2-3 with about 34-40%, where the options are no antibiotic or a back-up prescription to start if you are not improving in three to five days; and 4-5 with about 62-65%, where an immediate or back-up antibiotic is reasonable. The Centor score, used widely elsewhere, gives a point each for pus on the tonsils, tender swollen front neck glands, fever above 38°C and no cough: 0-2 points suggests a 3-17% likelihood and 3-4 points about 32-56%. When a score is borderline, a throat swab can refine the decision.
Treatment: penicillin V first, and good pain control
When antibiotics are indicated, phenoxymethylpenicillin, usually called penicillin V, is the first-line choice: a narrow, well-tested antibiotic to which group A strep has not become resistant. Adults usually take 500 mg four times a day, or 1 g twice a day, for 5 to 10 days as directed. People allergic to penicillin are usually given clarithromycin, or erythromycin in pregnancy. We avoid amoxicillin when glandular fever is possible, because it can trigger a widespread itchy rash in that infection.
Pain control matters just as much, because dehydration is the main reason tonsillitis ends in hospital. Take paracetamol regularly, gargle with salt water, and use anaesthetic lozenges and cold fluids; with a high fever in Phuket, avoid ibuprofen until dengue has been considered. Tonsillectomy is reserved for frequent, severe episodes, typically seven or more in a year, five a year for two years, or three a year for three years, and is planned with an ear, nose and throat (ENT) specialist at home.
Glandular fever and the Muay Thai question
Glandular fever, or infectious mononucleosis, can look exactly like severe tonsillitis. It mostly affects teenagers and young adults, and brings very swollen tonsils, fever, glands at the back of the neck as well as the front, and a heavy fatigue that can last weeks. A blood test confirms it, and antibiotics do not help. The spleen can enlarge, and a blow to the abdomen can rupture it, so sparring, clinch work, contact sports and heavy lifting must stop for at least four weeks, longer if the spleen stays enlarged. For people who came to Phuket to train, that is not advice to bend.
When to see a doctor
In the weeks after a strep throat, a new rash, dark urine, swollen ankles or aching joints need assessment, because rare complications affect the kidneys and joints.
Prevention and early detection
There is no vaccine against strep, so prevention means limiting spread in hostels, tour groups and training camps: wash your hands, do not share bottles or utensils, keep away from others for 24 hours after starting antibiotics, and replace your toothbrush once you are better. Early detection means recognising the one-sided warning signs of quinsy and seeking help at the first sign of dehydration. If episodes keep recurring, record the dates and swab results for your ENT specialist at home.
How to see a doctor for tonsillitis
Our clinics never close, so you can walk in whenever the pain peaks, including the middle of the night. Choose the nearest: the Bangtao (Cherngtalay) clinic, the Kata-Karon clinic or the Patong clinic. You will usually be seen within minutes, with medicine from our on-site pharmacy. To stay in bed instead, message our WhatsApp line or call +66 81 718 9080 to arrange a hotel visit by a doctor. We confirm the price on WhatsApp before your visit, bill most travel insurers directly, and refer you straight to a hospital ENT specialist if quinsy is suspected.
Related treatments and services
Throat pain with sudden aches and exhaustion may be influenza, covered under flu treatment, and a positive coronavirus swab leads to COVID-19 treatment. Ear pain usually comes from the throat, but a true middle ear infection needs ear infection treatment, and an unexplained high temperature is covered under fever treatment. A cough that settles in the chest afterwards is described under bronchitis treatment, throat viruses often trigger wheeze in people with asthma, and a scratchy throat with sneezing suggests allergy treatment instead. See also our walk-in doctor in Phuket service and all the conditions we treat.
Summary
Tonsillitis is usually viral, and pus on the tonsils alone does not mean you need antibiotics. A FeverPAIN or Centor score guides the decision, and penicillin V is the first choice when strep is likely. Keep drinking, control the pain, stop contact training if glandular fever is diagnosed, and get same-day help for one-sided swelling, drooling or trouble opening your mouth.
“If you are prescribed antibiotics for tonsillitis, finish the full course even when you feel better after a few days. It lowers the risk of complications.”
Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket
Frequently asked questions
What does my FeverPAIN score actually mean?
It estimates the chance that group A strep is causing your tonsillitis. One point each is given for fever, pus, being seen within three days, badly inflamed tonsils and no cough or cold. A score of 0 or 1 means antibiotics are unlikely to help, 2 or 3 is a grey zone, and 4 or 5 makes an antibiotic reasonable.
My tonsils are covered in white spots. Why no antibiotics?
White or yellow spots of pus appear with viral tonsillitis, including glandular fever, as well as with strep, so they are only one clue. If the rest of the picture points to a virus, antibiotics would add side effects without speeding recovery. Where the score is borderline, the doctor may give a back-up prescription.
How quickly will antibiotics work, and when am I no longer contagious?
With penicillin V for strep tonsillitis, most people notice the fever and pain easing within 24 to 48 hours, and are no longer infectious after about 24 hours of treatment. Finish the full course. If you are not improving after 48 hours, come back, because it may be viral, glandular fever or an early abscess.
Do I need an appointment, or can a doctor come to my hotel?
You do not need an appointment: all three clinics accept walk-ins 24 hours a day, and most visits take under 30 minutes. If swallowing is so painful you are struggling to drink, a doctor can come to your hotel, villa or condo anywhere in Phuket instead, day or night. Send a WhatsApp message with your location.
I train Muay Thai. Can I keep training with tonsillitis?
Not while you have a fever, and not at all if the cause is glandular fever. Training hard with a fever strains the heart and slows recovery. Glandular fever can enlarge the spleen, and a kick or knee to the abdomen could rupture it, so contact training should stop for at least four weeks. Ask the doctor when it is safe to return.
Will my travel insurance cover treatment for tonsillitis?
Most travel insurance covers acute illness such as tonsillitis, although excesses and conditions vary, so check your policy. We bill most travel insurers directly and can provide a medical report, receipt and itemised invoice for claims you make yourself. We confirm the price on WhatsApp before your visit.
Sources
The NHS describes symptoms and when to get help on its tonsillitis page. NICE sets out the FeverPAIN and Centor thresholds and antibiotic choices in its sore throat (acute) antimicrobial prescribing guideline. MedlinePlus covers causes and tonsil surgery on its tonsillitis overview.
Tonsillitis, acute tonsillitis, strep throat, group A streptococcus, FeverPAIN score, Centor criteria, penicillin V, phenoxymethylpenicillin, clarithromycin, erythromycin, glandular fever, infectious mononucleosis, Epstein-Barr virus, quinsy, peritonsillar abscess, tonsillectomy, ENT, NICE, NHS, Bangtao, Cherngtalay, Kata, Karon, Patong, Takecare Clinic Phuket, Dr. Ponlawat Pitsuwan
This page is general health information and not a substitute for a medical consultation.