Sore Throat, Tonsillitis and Sinusitis in London 2026. When Antibiotics Help, When They Do Not and What to Watch For
Sore throat is one of the commonest reasons anybody sees a doctor, and the overwhelming majority are viral, self-limiting and made no better by antibiotics. The useful question is not whether it hurts but how likely a bacterial cause is, and clinicians answer that with a score rather than a guess. The FeverPAIN score awards a point each for fever in the past 24 hours, purulence on the tonsils, attendance within 3 days of onset, severely inflamed tonsils and the absence of cough or coryza. A score of 0 or 1 carries roughly a 13% to 18% chance of streptococcal infection and needs no antibiotic. A score of 4 or 5 carries around 62% to 65%, and treatment becomes reasonable. Acute sinusitis follows the same logic. It is viral in the great majority of cases, symptoms commonly last 2 to 3 weeks, and NICE advises against antibiotics for most people with symptoms of fewer than 10 days. What matters far more than the prescription is recognising the small number of presentations that are not simple infection at all. Difficulty swallowing saliva, drooling, a muffled voice, severe one-sided pain with trismus, neck swelling, or any breathing difficulty needs urgent assessment, because quinsy, epiglottitis and deep neck space infection all present as a sore throat first. At The Wellness you are examined the same day, 7 days a week, from £59 for a mini consultation, £150 by video, £220 in person or £495 at your home or hotel. Fees appear further down this page.
Reviewed by the medical team at The Wellness. Last updated 1 September 2026.
Get seen today on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
When is a sore throat an emergency
Difficulty swallowing your own saliva, or drooling, means the airway is at risk and needs assessment now rather than tomorrow. A muffled or hot potato voice, severe pain on one side with difficulty opening the mouth, and swelling of the neck are the features of quinsy, a peritonsillar abscess, which needs drainage rather than tablets.
Any difficulty breathing, stridor, or sitting forward to breathe more easily needs 999. Epiglottitis is rarer since vaccination but still occurs in adults and deteriorates quickly.
A sore throat with a widespread rash, a very high fever, confusion, or a rash that does not fade under a glass needs emergency assessment. So does a sore throat in anyone taking carbimazole, methotrexate, clozapine or chemotherapy, where a low white cell count is possible and an urgent blood count is needed rather than reassurance.
And a sore throat persisting beyond 3 weeks, particularly with hoarseness, a neck lump, ear pain on one side, difficulty swallowing or unexplained weight loss, warrants assessment under the head and neck cancer pathway in NICE guideline NG12 rather than another course of antibiotics.
Everything outside those categories is the large majority, and the large majority gets better on its own.
Do I need antibiotics for a sore throat
Usually not, and the score is how that decision is made rather than how convincing the throat looks. FeverPAIN awards a point each for fever in the previous 24 hours, purulence, attendance within 3 days of symptom onset, severely inflamed tonsils, and no cough or coryza. Centor is the older alternative and works similarly.
At 0 or 1 the chance of streptococcal infection is roughly 13% to 18% and no antibiotic is indicated. At 2 or 3 it rises to around 34% to 40%, and a back-up prescription to use only if things worsen is a reasonable approach. At 4 or 5 it reaches around 62% to 65% and immediate treatment is appropriate.
Even where streptococcus is present, antibiotics shorten symptoms by roughly 16 hours on average. They are given to reduce complications and to shorten illness in those scoring highly, not because they transform a sore throat.
Glandular fever deserves its own mention because it is regularly missed and regularly mistreated. In a teenager or young adult with a severe sore throat, marked fatigue, large tender neck glands and a swollen spleen, a blood test settles it, and amoxicillin given in that situation causes a florid rash in a large proportion of patients. Contact sport should be avoided for several weeks because of splenic rupture risk.
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How long does sinusitis last and when does it need treating
Longer than almost everyone expects. Acute sinusitis commonly runs 2 to 3 weeks, and NICE advises against antibiotics for people with symptoms of fewer than 10 days, because the cause at that stage is viral in the great majority of cases and antibiotics make little difference.
The pattern that changes the assessment is described as double worsening. Symptoms improve and then deteriorate again, or persist beyond 10 days without improvement, with severe localised pain, purulent discharge and fever. That combination raises the likelihood of bacterial infection and is where a back-up or immediate prescription becomes reasonable.
What helps in the meantime is unglamorous and effective. Saline nasal irrigation, which physically clears the nose and improves how well anything else works. An intranasal corticosteroid, particularly where there is an allergic component, remembering it takes up to 2 weeks to reach full effect. Simple analgesia. Decongestants for no more than 5 to 7 days, because longer use causes rebound congestion that is worse than the original problem and is a common cause of the chronic blocked nose people attribute to sinusitis.
Recurrent or chronic sinusitis is a different problem and needs a different approach, including assessment for allergic rhinitis, nasal polyps, a deviated septum and dental causes, with ENT referral where symptoms persist beyond 12 weeks.
Severe one-sided facial pain with swelling around the eye, double vision, a change in vision, or severe headache with confusion needs urgent assessment, because orbital and intracranial complications of sinusitis are rare and serious.
What is available without a doctor
Worth saying because it saves people money and we are not the right answer for everything. Pharmacy First in England covers 7 conditions without a GP appointment, and 2 of them are relevant here. Acute sore throat in anyone aged 5 and over, and acute sinusitis in anyone aged 12 and over. A pharmacist can assess you and supply prescription medicine where it is indicated, free if you are exempt from charges, with no appointment needed.
For a straightforward sore throat or a sinus infection in an otherwise well adult, that is a sensible first stop and we will tell you so.
Where it does not apply is where private assessment earns its place. Children under 5 with a sore throat. Anyone with a red flag from the section above. Recurrent tonsillitis being considered for tonsillectomy, which requires documented episodes. Suspected glandular fever needing blood testing. Sinusitis persisting beyond 12 weeks or recurring. Anyone immunosuppressed or on medication affecting the white cell count. And anyone who has already been through the pharmacy or an NHS appointment and is no better.
What does assessment cost in London
Consultant ENT appointments in the Harley Street district run £250 to £450 for a first consultation, with nasendoscopy, imaging and follow-ups charged separately, and private CT of the sinuses commonly £500 to £900. Harley Street GP consultations sit at £250 to £350. Walk-in private clinics charge £75 to £150 for a short appointment, frequently without examination equipment for ears and throat. Below all of it sits a tier defined by its conditions rather than its price, remote appointments issuing antibiotics without anybody looking at the throat, which is how a quinsy gets a prescription instead of a drainage.
At The Wellness the consultation, the examination and any testing are handled together. All figures are from prices.
Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, from £11,995.
Home, hotel or office visit, evenings and weekends from £695 and daytime from £495, with additional household members from £195 each.
Comprehensive Blood Panel with consultation and interpretation, from £495, covering glandular fever testing, full blood count and inflammatory markers where indicated.
Extended 45-minute consultation for recurrent or chronic presentations with a written plan, from £395.
In-person consultation with full ear, nose and throat examination in Marylebone, from £220.
Same-day video consultation, from £150. Mini consultation, from £59.
Throat swab and blood testing arranged at an accredited partner laboratory. CT sinuses, nasendoscopy and ENT referral to a named consultant arranged at specialist centres with the appointment booked.
Same-day appointments 7 days a week at 10 Portman Square, Marylebone, 3 minutes from Baker Street.
Why The Wellness is the best place in London for a sore throat or sinus infection
Because you are examined, which for a throat is most of the diagnosis and is the part a remote appointment cannot do. A quinsy, an epiglottitis and a straightforward viral pharyngitis all begin as a sore throat, and the difference is visible and audible rather than describable.
Because the antibiotic decision is made on a score rather than on how much you want one. A FeverPAIN of 1 gets an explanation, a realistic timeline and the specific signs that should bring you back. A FeverPAIN of 4 gets treatment in the appointment. Both are the right answer and only one is popular.
Because the things that get missed are looked for. Glandular fever tested rather than assumed absent in a young adult with severe fatigue, which also prevents the amoxicillin rash. A low white cell count checked in anyone on carbimazole, methotrexate or clozapine. Sinusitis beyond 12 weeks assessed for polyps, allergy and septal deviation rather than given a fourth course of antibiotics.
Because we tell you when the pharmacy is the better option, since Pharmacy First covers sore throat from age 5 and sinusitis from age 12 free of charge. That costs us appointments and it is the reason our recommendation is worth something when it goes the other way.
And because same-day appointments exist 7 days a week, in the clinic, by video, or at your home or hotel, which is when these things actually happen.
Related reading
Persistent cough and chest infections covers the lower respiratory side and the 3-week rule, allergy testing and hay fever covers the allergic causes of chronic nasal symptoms, private GP for children and families covers unwell children, ear wax removal covers blocked ears, and private GP in London covers the full consultation range.
Book a same-day appointment on WhatsApp or call 020 3951 3429.
Frequently asked questions
Do I need antibiotics for a sore throat
Usually not. The decision is made with a score rather than by appearance. FeverPAIN awards a point each for fever in the past 24 hours, purulence, attendance within 3 days, severely inflamed tonsils and no cough or coryza. A score of 0 or 1 carries roughly a 13% to 18% chance of streptococcal infection and needs no antibiotic, while 4 or 5 carries around 62% to 65% and treatment is appropriate.
When is a sore throat an emergency
Difficulty swallowing saliva or drooling, a muffled voice, severe one-sided pain with difficulty opening the mouth, neck swelling, or any breathing difficulty. Those are the features of quinsy and epiglottitis and need urgent assessment. A sore throat in anyone taking carbimazole, methotrexate or clozapine needs an urgent blood count.
How long does sinusitis last
Commonly 2 to 3 weeks. NICE advises against antibiotics for symptoms of fewer than 10 days because the cause is viral in the great majority of cases. Double worsening, meaning improvement then deterioration, or persistence beyond 10 days with severe localised pain, purulent discharge and fever, is where treatment becomes reasonable.
Can a pharmacist treat a sore throat or sinusitis
Yes. Pharmacy First in England covers acute sore throat from age 5 and acute sinusitis from age 12, with the pharmacist able to supply prescription medicine where indicated, free if you are exempt from charges and with no appointment needed. For a straightforward case in an otherwise well adult that is a sensible first stop.
Could it be glandular fever
In a teenager or young adult with a severe sore throat, marked fatigue and large tender neck glands, yes, and a blood test settles it. It matters because amoxicillin given in glandular fever causes a florid rash in a large proportion of patients, and because contact sport should be avoided for several weeks due to splenic rupture risk.
What helps sinusitis apart from antibiotics
Saline nasal irrigation, an intranasal corticosteroid particularly where there is an allergic component, and simple analgesia. Decongestants should be used for no more than 5 to 7 days, because longer use causes rebound congestion that is worse than the original problem.
The Wellness is a doctor-led private healthcare group providing medical care from 10 Portman Square, Marylebone, adjacent to Harley Street. All doctors are GMC-registered. Blood analysis is performed by accredited laboratories and imaging is arranged at specialist centres and reported by consultant radiologists. Difficulty swallowing saliva, drooling, a muffled voice or any breathing difficulty needs urgent assessment, and in an emergency call 999. This article is general information and not a substitute for medical advice about your own health.
Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.
References. NICE guideline NG84, sore throat acute, antimicrobial prescribing, including FeverPAIN and Centor scoring and associated streptococcal probabilities. NICE guideline NG79, sinusitis acute, antimicrobial prescribing. NICE guideline NG12, suspected cancer recognition and referral, head and neck provisions. NICE Clinical Knowledge Summaries on sore throat, glandular fever, sinusitis and chronic rhinosinusitis. NHS England Pharmacy First service specification and the 7 clinical pathways. Published evidence on the effect size of antibiotics in streptococcal pharyngitis. Published 2026 London private ENT and general practice market pricing.
