Tonsillitis (namamagang tonsil): symptoms, medicine and danger signs

Your tonsils are two small lumps at the back of the throat that help fight germs. When they are infected, many Filipinos say "may tonsil ako" or "namamaga ang tonsil". The medical name is tonsillitis.

Common symptoms are:

• a sore throat and pain when swallowing
• red, swollen tonsils, sometimes with white or yellow spots of pus
• fever, headache, ear pain and tiredness
• swollen, tender glands on the side of the neck

Young children may not say their throat hurts; they may refuse food or drinks, or vomit. Drooling in a child is a danger sign.

Most tonsillitis gets better in 3 to 4 days, but it can last about a week. A sore throat with a runny nose and cough is often a common cold. For sore throats in general, see our sore throat guide.

Most tonsillitis is caused by a virus, often the same viruses that cause colds and flu (trangkaso). Antibiotics do not kill viruses.

Some tonsillitis is caused by bacteria, most often group A streptococcus, the germ behind strep throat. Strep is most common in children aged 5 to 15, but anyone can get it.

Glandular fever, caused by another virus, can cause severe tonsillitis in teenagers and young adults. It spreads through saliva, such as kissing, can take weeks to clear, and antibiotics don't help.

Tonsillitis itself does not spread, but its germs do, through coughs, sneezes, saliva and shared cups. You can get it more than once.

A doctor or nurse will ask questions and look in your throat. Strep is more likely with:

• a fever
• pus on the tonsils, or very red, swollen tonsils
• tender, swollen glands at the front of the neck
• no cough or runny nose
• symptoms that began in the last 3 days

The more of these signs, the more likely strep is. This checklist guides the health worker; it can't tell you at home whether you need an antibiotic.

The doctor may also do a throat swab with a long cotton bud. A rapid strep test can miss some cases, so the swab may also be sent to a lab.

These steps ease the pain, whatever the cause:

• Rest, and stay home while you have a fever.
• Drink plenty of fluids, cool or warm (not hot), such as water or salabat.
• Eat soft foods: lugaw or soup (warm, not hot), or cool ones such as jelly or ice cream.
• Gargle with warm salt water: stir half a teaspoon of salt into a glass of warm water, gargle and spit it out. Young children should not gargle.
• Paracetamol or ibuprofen ease pain and fever. Follow the label or ask your pharmacist. Never give aspirin to anyone under 16. If the fever could be dengue, our dengue guide says which pain relievers to avoid.
• Medicated throat lozenges may ease the pain a little in adults. Don't give lozenges or hard candy to young children, who can choke.

Pregnant, breastfeeding, treating a child, or living with a long-term illness? Ask a doctor before using any medicine. You can also ask our medicines helper.

Most people with tonsillitis do not need antibiotics. On average they shorten a sore throat by only about 16 hours (UK guidance), and they can cause diarrhea and nausea.

A doctor may prescribe one when strep is likely, when you are very unwell, or for a complication such as quinsy. For strep, antibiotics help prevent rare but serious problems such as rheumatic fever. This matters in the Philippines, where rheumatic fever is still seen. Penicillin or amoxicillin are usually tried first. Tell the doctor if you have ever reacted to penicillin, so they can choose another antibiotic.

If you are prescribed one:

• take every dose for as many days as the doctor says, even if you feel better sooner
• don't share it or keep leftovers
• go back if you are not better 1 to 2 days after starting it, or at once if you get worse

Don't buy antibiotics without a prescription. In 2012 the DOH and FDA told pharmacies not to sell them without one. Misuse helps germs become resistant, so antibiotics stop working.

"Bawal ang malamig at ice cream." Germs cause tonsillitis, not cold drinks. Health services suggest cool drinks and soft, cool foods to soothe the throat.

"Tusukin o kayurin ang puti sa tonsil." Don't poke, scrape or squeeze the white spots. It does not treat the infection and can hurt the throat.

Kalamansi or vinegar gargles. We found no proof that they help, and they can sting a raw throat. Use warm salt water instead.

"Ipatanggal na lang ang tonsil." Few people need this (see when tonsils need to be removed).

Quinsy (peritonsillar abscess) is a pocket of pus next to a tonsil. It is most common in teenagers and young adults. Signs are:

• severe throat pain that quickly gets worse, usually on one side
• trouble opening the mouth, and drooling
• a muffled voice
• a swollen or stiff neck

The swelling can block the airway, so quinsy needs the ER now. Doctors drain the pus with a needle or a small cut and give antibiotics.

Epiglottitis is swelling of the flap above the windpipe. It causes a very sore throat, drooling and noisy breathing. Keep the person upright and go to the ER at once. The Hib vaccine, part of the routine baby vaccines, protects against its most common cause.

Strep throat can also bring scarlet fever (a rough, sandpaper-like rash and a red, bumpy tongue). Later, a few people get kidney inflammation or rheumatic fever, which can show up weeks after the sore throat and can scar the heart valves for life. The World Health Organization says treating strep throat with the right antibiotic prevents rheumatic fever.

• Under 5 with a sore throat and fever? See a doctor or go to your health center the same day. See fever in babies and children.
• Medicines. Ask a doctor or pharmacist before giving any medicine, including herbal ones. Never give aspirin.
• Keep them drinking. Offer drinks, breast milk or soft foods, and watch for peeing less than usual.
• School. Keep your child home until the fever is gone and they can swallow comfortably, usually 3 to 4 days. With strep, they should stay home until they have taken antibiotics for at least a full day.
• Loud snoring or pauses in breathing at night can happen when large tonsils block the airway. Tell your doctor.

For help any time, ask our symptoms guide.

Few people need a tonsillectomy, an operation to remove the tonsils. An ear, nose and throat (ENT) doctor may suggest it when:

• throat infections are very frequent: about 7 or more in one year, or 5 or more a year for 2 years
• large tonsils block breathing during sleep
• there has been quinsy, or there is a growth on a tonsil

The patient is asleep during it (general anesthesia). Many go home the same day; some stay one night. Recovery takes about 1 to 2 weeks. The main risk is bleeding, which sometimes shows as vomiting blood and needs the ER right away. Our preoperative checklist can help you prepare. To find a specialist, search for an ENT doctor.

• Barangay health station, rural health unit (RHU) or city health center. Find one near you.
• PhilHealth YAKAP. Check-ups at your registered YAKAP clinic are free, though as of July 2025 a private YAKAP clinic may charge up to ₱900 per patient a year. See our PhilHealth YAKAP guide.
• Free medicines through PhilHealth GAMOT. As of 2026, the GAMOT list includes amoxicillin and co-amoxiclav for some throat infections. If your YAKAP doctor prescribes one, an accredited GAMOT pharmacy gives it free, up to ₱20,000 a year for each member and each dependent (as of July 2025).
• Hospital care. In the newest PhilHealth case-rate lists we found (Circular 2024-0037), PhilHealth pays ₱7,800 for a hospital stay for acute tonsillitis, ₱19,500 for quinsy, ₱16,107 for draining a quinsy and ₱35,100 for a tonsillectomy. These cover hospital and doctor's fees together. See what PhilHealth covers.
• Help with bills. Malasakit Centers in many hospitals bring PhilHealth, PCSO and DSWD aid to one desk for patients who can't pay.
• After rheumatic fever. At PhilHealth-contracted facilities, an outpatient package covers the regular penicillin injections that prevent new attacks and a yearly heart ultrasound (₱12,000 per patient a year under its 2019 rules).

Our free care navigator can help you find free care, or book a call with a nurse.

There is no vaccine against tonsillitis. To lower the chance of passing on the germs:

• Wash your hands often, and cover coughs and sneezes.
• Don't share cups, spoons or toothbrushes with someone who is sick.
• Stay home while you have a fever.
• With strep, get a new toothbrush after 2 or 3 days on antibiotics.
• Get strep throat treated when a doctor finds it, to protect the heart.

More guides on germs that cause fever are in our infections and fever hub.