Sore Throat in London: When Do You Need Antibiotics?

Most sore throats, including tonsillitis, improve within a week without antibiotics. The important decision is not whether your throat hurts badly, but whether an antibiotic is likely to help and whether there is a sign of something more serious. NICE recommends using the FeverPAIN or Centor criteria alongside an examination. A good consultation should leave you with pain relief, a clear plan and a reason for any prescription, not simply a box of tablets.

Is my sore throat viral or bacterial?

A sore throat can be caused by a virus or bacteria, and a look at the tonsils alone may not settle it. A cough or runny nose alongside the pain makes a viral illness more likely. Fever, pus on the tonsils, swollen tender neck glands and no cough make a streptococcal infection more plausible, but none of these signs is a guarantee. NICE advises clinicians to use a score called FeverPAIN or Centor to estimate who might benefit from an antibiotic. https://www.nice.org.uk/guidance/ng84/chapter/recommendations

What does FeverPAIN mean?

It stands for fever in the previous 24 hours, purulence (pus) on the tonsils, attendance within three days of symptoms starting, severely inflamed tonsils, and no cough or coryza (cold symptoms). Each feature scores one point. It is a decision aid used by a clinician, not a home diagnosis or an instruction to take antibiotics. Other illnesses, including glandular fever, can give a very sore throat and swollen glands.

For a FeverPAIN score of zero or one, NICE says not to offer an antibiotic. For two or three, a clinician may choose no antibiotic or a back-up prescription after discussing your symptoms. At four or five, an immediate or back-up antibiotic may be considered. People who are systemically very unwell or at high risk of complications need individual assessment. Even where an antibiotic is appropriate, the average shortening of sore-throat symptoms is modest, around 16 hours in the evidence NICE reviewed. The benefit has to be weighed against side effects. https://www.nice.org.uk/guidance/ng84/chapter/recommendations

When should I get urgent help?

Get urgent advice if you cannot swallow, are drooling, have trouble breathing, a high-pitched breathing noise, or symptoms that are rapidly getting worse. These can be signs of an airway problem or a complication, not an ordinary sore throat. NHS sore throat advice says to call 999 or go to A&E for difficulty breathing, inability to swallow, drooling or noisy breathing. If you are very unwell, immunosuppressed, or dehydrated because swallowing is too painful, seek prompt medical assessment. https://www.nhs.uk/symptoms/sore-throat/

What can I do for pain now?

Drink enough fluid, rest, and consider paracetamol or ibuprofen if safe for you. Warm or cool drinks and soft food may be more comfortable. Lozenges may help some adults, but they do not treat the cause. If symptoms do not start to improve after about a week, get assessed. Do not take someone else’s antibiotics or a leftover course.

What happens at a private GP visit?

The GP asks when the symptoms started, checks for fever, cough and cold symptoms, examines your throat and neck, and considers other diagnoses where appropriate. They can explain your FeverPAIN or Centor score, decide whether no prescription, a back-up prescription or treatment now is justified, and set out what should trigger another review. If the signs suggest a serious complication, they arrange urgent onward care rather than treating it as routine tonsillitis.

What will the appointment cost?

The value is the clinical judgement about when medicine is useful and when it is not. The Online GP lists a same-day telephone consultation at £59 and an in-person Marylebone GP appointment at £220. A telephone appointment can help triage symptoms, but if the throat needs examining or a complication is possible, in-person care is the more useful route. Separate tests or treatments, if needed, should be discussed before they are arranged.

Telephone appointments: https://www.theonlinegp.com/services-store/p/same-day-telephone-gp

In-person appointments: https://www.theonlinegp.com/services-store/p/same-day-urgent-in-person If you are unsure which route fits, contact The Online GP: https://www.theonlinegp.com/contact . For the urgent symptoms above, use emergency services rather than wait for a private appointment.

Frequently asked questions

Does white pus on the tonsils mean I need antibiotics? Not by itself. It is one part of the FeverPAIN score. A clinician considers the full picture and other possible diagnoses before prescribing.

How long should a sore throat last? Most improve within about one week, with or without antibiotics. Seek reassessment if you are worsening rapidly, very unwell or not beginning to improve after a week.

Can I get antibiotics at a same-day GP appointment? A clinician can prescribe them when appropriate. NICE recommends no antibiotic at low FeverPAIN scores and a choice of no, back-up or immediate treatment at higher scores depending on the case.

When is a sore throat an emergency? Difficulty breathing, inability to swallow, drooling or noisy breathing needs emergency help rather than a routine GP slot.

General information, not a personal diagnosis. Written and reviewed by the clinical team at The Wellness. Updated September 2026.