Tonsillitis | Pokenga repe korokoro

Key points about tonsillitis

  • Tonsillitis (pokenga repe korokoro) is when the tonsils at the back of your throat become red and swollen (inflamed).
  • Tonsillitis is common in children over 2 years of age but teenagers and adults can get it too.
  • Treatment for tonsillitis is usually rest and pain relief.
  • Surgical removal of your tonsils (tonsillectomy) may be considered if you get tonsillitis often.
  • Tonsillitis might actually be rheumatic fever which is a serious condition, so know when to seek urgent care.
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Tonsils are two small, rounded masses of tissue that can be seen in the back of the throat. They are made of tissue similar to the lymph glands and are part of the immune system. The tonsils are thought to help protect the body from infection during the first year of life but are not essential for immune function in later life.

Tonsillitis is the medical name for when your tonsils become red and swollen (inflamed). Tonsillitis can happen more than once.


Tonsillitis is usually caused by viruses, such as those related to colds. You can inhale the viruses through droplets in the air from people sneezing and coughing, or by contact with secretions from the nose or throat of people with the infection. Tonsillitis may be a symptom of the Epstein-Barr virus which causes glandular fever; this is more common in teenagers.


The main type of bacteria causing tonsillitis is Streptococcus, which causes a strep throat infection. If you have strep throat you need to take antibiotics. Untreated strep throat can lead to serious complications, such as rheumatic fever (which can cause permanent damage to your heart) or inflammation of your kidneys. Read more about rheumatic fever.

Symptoms of tonsillitis
  • sore throat (often severe)
  • red and swollen tonsils
  • hoarse or no voice
  • a high temperature (fever) of 38°C or above
  • difficulty swallowing
  • headache
  • runny nose
  • congestion
  • swollen lymph nodes (glands) on either side of your neck
  • possibly pus on tonsils
  • possibly muscle aches and a feeling of being unwell
  • young children may say they have a tummy ache.

You should see your doctor urgently if you are in any of the groups below.

Risk of rheumatic fever

The bacteria that causes tonsillitis can cause rheumatic fever. This is a very serious condition that can lead to damage of the heart and kidney disease. It is important that you seek urgent medical advice if you have any signs of tonsillitis and have:

  • a personal, family, or household history of rheumatic fever, or
  • two or more of the following:
    • Māori or Pacific ethnicity
    • aged 3 to 35 years
    • living in crowded accommodation or a lower socio-economic area.

If you or your child:

  • have difficulty breathing
  • can't swallow saliva, which may cause dribbling
  • can't get enough fluids
  • have severe pain
  • have ongoing high fever
  • aren't improving after two days
  • have earache or joint pain.

If you are unsure what to do, phone Healthline on freephone 0800 611 116. Calls are free and are answered by registered nurses or other health professionals who can help you.

Usually your doctor will only need to hear your symptoms and look at your throat. As tonsillitis may be a symptoms of another condition, they may do more tests.

If you are at risk of rheumatic fever or if you have a job where you are at risk of spreading an infection (such as teacher or being a student), you may have a swab taken from your throat to check for strep throat.

If your doctor thinks you might have glandular fever they will take a blood test.

Mild tonsillitis often doesn't need any treatment and symptoms get better in 2 or three days.

Self-care for tonsillitis


Children and adults need rest to recover from tonsillitis.

Fluids and food

Make sure the person with tonsillitis drinks plenty of fluids, mainly water, especially if there is fever. 

  • Offer cold drinks, sips of ice to suck or ice blocks. They may like some soft foods such as jelly, ice cream or custard.
  • Don’t worry if not much is eaten for a few days, as long as fluid intake is kept up. 
  • Children and older adults should be taken to the doctor if they have not managed to drink anything for 15 hours.
Medications for tonsillitis

Pain relief medications

Taking pain relief medicines such as paracetamol may ease your symptoms and may allow you to eat and drink more comfortably. Read more about paracetamol.

  • You can also use ibuprofen, an anti-inflammatory medicine, to ease the pain but ibuprofen may not be suitable if you have some medical conditions. Read more about ibuprofen.

Gargling may help

Older children and adults may be able to gargle with warm salt water to relieve sore throats, help remove secretions and promote healing. You can make salt water by mixing half teaspoon of salt to a cup of warm water. Children must be old enough to gargle and they must spit out the water after gargling.

  • Sore throat products are available from your pharmacy such as lozenges, sprays or gargles. Some contain anaesthetics (numbing agents) and may provide temporary relief from soreness.
  • Most of these products can be used every 2 to 3 hours.
  • Some examples include:
    • Codral sore throat lozenges
    • Difflam lozenges
    • Difflam spray
    • Difflam mouthwash
    • Strepsils lozenges
    • Strepfen Intensive lozenge
    • Cepacaine mouthwash
  • Talk to your pharmacist about the best pain relief for you or your child. Medicated throat lozenges are not suitable for children.
  • Some lozenges have a high sugar content and may not be suitable for people with diabetes.

Do I need antibiotics?

Antibiotics are not usually needed to treat tonsillitis because tonsillitis is mostly caused by viruses (a viral infection). Antibiotics only work against bacteria (a bacterial infection) but not viruses.

Your doctor may give you antibiotics for tonsillitis if:

  • your symptoms are severe
  • you are at high risk of getting rheumatic fever— for example Māori tamariki or Pasifika children or people living in crowded home circumstances
  • if you are immunocompromised
  • if you suffer from recurrent tonsillitis.

If you are started on antibiotics, it is very important to complete the course even if you feel better before your course is finished.

Surgery to remove the tonsils

An operation to remove the tonsils (tonsillectomy) may be considered if you have frequent bouts of tonsillitis. Read more about tonsillectomy.

Other children or family members should be kept away from the person with tonsillitis if possible. To prevent the spread of infection, use good hygiene measures including:

  • regularly washing hands
  • using a tissue or inside of the elbow to cover coughs and sneezes
  • not sharing eating utensils or drinking vessels
  • frequent cleaning of surfaces, particularly in the kitchen and bathroom
  • keeping your home warm and dry. See here for support.(external link)

The following links provide further information about tonsillitis. Be aware that websites from other countries may have information that differs from Aotearoa New Zealand recommendations.    

Tonsillitis(external link) Southern Cross, NZ
Tonsillitis(external link) HealthInfo, NZ
Tonsillitis(external link) NHS, UK
Sore throats matter – help prevent rheumatic fever(external link) Health Promotion Agency, NZ, 2012


Virus action plan (adults)(external link) He Ako Hiringa, NZ
Virus action plan (child over 6 months)(external link) He Ako Hiringa, NZ


  1. Heart Foundation. group A Streptococcal sore throat management  guideline. 2019(external link) Heart Foundation, NZ, 2019
  2. The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition)(external link) 
  3. Sore throat(external link) Health New Zealand | Te Whatu Ora
  4. Tonsillitis and sore throat(external link) 3D HealthPathways, NZ. Subscription only

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Maya Patel, MPharm PGDipClinPharm, Auckland

Last reviewed:

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