Tonsillitis Treatment in Phuket: Bacterial, Viral or Glandular Fever?
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
“The tonsillitis we see most often in Phuket is in young backpackers and gap-year travellers, sharing dorms, drinks and late nights. Some have strep and do well on penicillin within two days. A few have glandular fever, and several of those arrive with an itchy rash all over, because a pharmacy sold them amoxicillin. Getting the diagnosis right on the first visit spares them a lot of misery.” Dr. Ponlawat Pitsuwan
What is tonsillitis?
The tonsils are two pads of immune tissue at the back of the throat, one on each side. Tonsillitis means they are infected and inflamed. They become red and swollen, sometimes with white or yellow spots or a coating of pus, and swallowing becomes painful. It is most common in children and young adults, and it spreads through droplets, kissing and shared cups, bottles and vapes.
Roughly half of cases are viral, caused by the same viruses as colds and flu. Most of the rest are bacterial, mainly group A Streptococcus. A third important cause in teenagers and young adults is the Epstein-Barr virus (EBV), which causes glandular fever, also known as infectious mononucleosis or “mono”. It can make the tonsils enormous and coated in white exudate, and it lasts much longer than ordinary tonsillitis.
Symptoms, and how to tell the types apart
Typical tonsillitis causes a sore throat that is worse on swallowing, fever, swollen and tender glands in the neck, bad breath, a hoarse or thick voice and sometimes earache, which is pain referred from the throat. Children may complain of tummy ache or refuse to eat. A cough and runny nose point toward a viral cause, while fever with pus on the tonsils and no cough makes strep more likely. For a general scratchy throat without swollen tonsils, our guide to sore throat treatment is more relevant.
| Type | Typical clues | Treatment |
|---|---|---|
| Viral tonsillitis | Cough, runny nose, hoarse voice, milder fever | Pain relief, fluids, rest; better in 3 to 7 days |
| Bacterial (strep) tonsillitis | High fever, pus on tonsils, tender neck glands, no cough | Penicillin V; clarithromycin if penicillin-allergic |
| Glandular fever (EBV) | Age 15 to 25, severe tiredness, glands in the back of the neck, symptoms over 1 week | Blood test; supportive care; avoid amoxicillin; no contact sports |
| Quinsy (peritonsillar abscess) | Severe one-sided pain, drooling, difficulty opening the mouth, muffled voice | Same-day hospital ENT drainage and antibiotics |
How we diagnose and treat tonsillitis at Takecare
The doctor examines your throat, tonsils, neck glands and ears, checks your temperature, and asks how long you have been unwell and whether you can drink. We use a clinical score such as FeverPAIN or Centor to estimate the chance of strep, and a rapid strep swab where the result would change the decision. If glandular fever is suspected, a blood test for a full blood count and a glandular fever antibody test helps confirm it.
For bacterial tonsillitis, the first-line antibiotic in NICE guidance is penicillin V (phenoxymethylpenicillin), usually for 5 to 10 days. Penicillin V is a narrow-spectrum antibiotic, meaning it targets strep closely and disturbs your gut bacteria less than broader antibiotics. Take it on an empty stomach at evenly spaced times. For people allergic to penicillin, clarithromycin or erythromycin is used instead. Finish the course even if you feel better after two days.
Pain relief matters as much as antibiotics. Regular paracetamol or ibuprofen, anaesthetic throat sprays or lozenges, and cold drinks help you keep swallowing, which is what prevents dehydration. When the tonsils are very swollen and swallowing is hard, a doctor may give a single dose of a corticosteroid such as dexamethasone to reduce the swelling and pain more quickly. If difficulty swallowing means you cannot keep even fluids down, you may need fluids through a drip.
A tonsillectomy, surgical removal of the tonsils, is not a holiday treatment. It is considered only for frequent, well-documented episodes over several years or for repeated quinsy, and is decided by an ear, nose and throat surgeon; if you are in that situation, we can write a summary for your own doctor or arrange a specialist referral.
Glandular fever and travel
Glandular fever deserves a special mention for travellers. It causes extreme fatigue that can last weeks, and in some people the spleen, an organ in the upper left abdomen, becomes enlarged and fragile. A blow to the tummy can rupture it, so avoid contact sports, rugby, Muay Thai training, rough water sports and heavy lifting for at least a month, and until a doctor confirms it is safe. Avoid alcohol while your liver tests are abnormal. Most people are well enough to travel home, but may need to rest rather than continue an active itinerary.
When to see a doctor
See a doctor if you cannot eat or drink enough, if your tonsillitis is not improving after three or four days, if you have a high fever above 39°C, or if you have a weakened immune system. Come back if you are not getting better 48 hours after starting antibiotics. People who have had several bouts of tonsillitis in a year should also be reviewed, as they may benefit from specialist advice about tonsil removal when they return home.
Go straight to a hospital emergency department, or call 1669, if you have difficulty breathing, are drooling because you cannot swallow your own saliva, cannot open your mouth properly, have a muffled “hot potato” voice, or have severe pain and swelling on one side. These suggest quinsy, which needs drainage by an ENT (ear, nose and throat) specialist.
Prevention and early detection
Tonsillitis spreads through saliva, so do not share drinking glasses, bottles, straws, cigarettes or vapes, and wash your hands after touching your face. In dormitories and on group tours, keep your own water bottle. If you have strep, you stop being contagious about 24 hours after starting antibiotics, so stay away from others until then.
Early detection makes the biggest difference for quinsy. If your sore throat starts to become one-sided and you are finding it hard to open your mouth, come in the same day. An abscess caught early is simpler to treat.
Visiting Takecare Clinic in Phuket
Walk in at any hour to Takecare Bangtao in Cherngtalay, Takecare Clinic Kata-Karon or our clinic in Patong. No appointment is needed, most visits take under 30 minutes, and blood tests for common conditions are processed in our on-site laboratory.
If swallowing is too painful and you feel feverish, a doctor can come to your hotel or villa instead. Send a message on WhatsApp or call +66 81 718 9080.
We confirm the price on WhatsApp before your visit, provide direct billing with most travel insurers, and supply a medical report and itemised receipt for your claim.
Related services and treatments
Tonsillitis often comes with other infections. High fever and body aches may be influenza, which our flu treatment in Phuket page covers, and a positive antigen test means our COVID-19 care page is more relevant. Earache that persists after the throat improves may be a separate middle ear infection, and a lingering chesty cough can turn into acute bronchitis.
If you react to an antibiotic, our allergy treatment in Phuket page explains how drug rashes are managed, and anyone with asthma can find inhaler advice on our asthma care page. A walk-in doctor in Phuket is available at every branch for anything else.
Summary
Tonsillitis is common in young travellers and spreads through shared drinks and close contact. Viral tonsillitis settles with pain relief, bacterial tonsillitis responds to penicillin V, and glandular fever needs a blood test, rest and no amoxicillin. One-sided pain, drooling and a muffled voice suggest quinsy, which needs same-day hospital care. A proper examination on the first visit avoids the wrong antibiotic and a spoiled trip.
“If your tonsils are swollen and white, do not buy amoxicillin from a pharmacy and hope. Let us look first. If it is strep, penicillin works well; if it is glandular fever, the wrong antibiotic will give you a rash on top of everything else.” Dr. Ponlawat Pitsuwan
Frequently asked questions
Is tonsillitis viral or bacterial?
It can be either. Roughly half of cases are viral and settle without antibiotics. Bacterial tonsillitis is usually caused by group A Streptococcus and tends to bring high fever, pus on the tonsils and tender neck glands without a cough. The doctor uses a clinical score and, if needed, a rapid strep test to decide, so you only take antibiotics when they will actually help.
Why does amoxicillin cause a rash with glandular fever?
Glandular fever is caused by the Epstein-Barr virus, and in people with this infection amoxicillin and ampicillin very often trigger a widespread red, itchy rash a few days later. The exact reason is not fully understood, but it relates to how the immune system is reacting to the virus. It is usually not a lasting penicillin allergy, but the drug should be stopped.
How quickly will I feel better from tonsillitis?
With the right treatment, pain usually improves noticeably within two to three days, although it is common to take about a week to feel completely normal. Glandular fever takes longer, often two to four weeks, with tiredness lasting longer still. If you are not better after 48 hours of antibiotics, or you get worse, come back for review.
Do I need an appointment for tonsillitis treatment?
No. All three Takecare branches in Bangtao, Kata and Patong accept walk-ins 24 hours a day, every day. You are usually seen within minutes, and medicine is dispensed from our on-site pharmacy before you leave. If you prefer, message us on WhatsApp so we know you are coming.
Can a doctor see me for tonsillitis in my hotel?
Yes. Our doctors visit hotels and villas anywhere in Phuket, day or night. The doctor can examine your throat and neck, take a strep swab if needed, and bring the first dose of medicine. This is helpful when fever and pain make it hard to travel, or when a child is unwell.
Is tonsillitis treatment covered by travel insurance?
Most travel insurance policies cover the consultation, tests and medicine for tonsillitis that begins during your trip. We offer direct billing with most travel insurers, and for policies that reimburse you later we provide a medical report and itemised receipt. Send us your insurer’s details on WhatsApp and we will confirm before you visit.
Sources
NHS: Tonsillitis. NHS: Glandular fever. NICE guideline NG84: Sore throat (acute), antimicrobial prescribing.
Tonsillitis, acute tonsillitis, strep throat, group A Streptococcus, viral tonsillitis, glandular fever, infectious mononucleosis, Epstein-Barr virus, EBV, quinsy, peritonsillar abscess, FeverPAIN, Centor criteria, rapid strep test, glandular fever blood test, penicillin V, phenoxymethylpenicillin, clarithromycin, erythromycin, amoxicillin rash, dexamethasone, enlarged spleen, ENT, NICE NG84, NHS, Bangtao, Cherngtalay, Kata, Karon, Patong, Phuket, Dr. Ponlawat Pitsuwan, Takecare Clinic Phuket.
This page is general health information and not a substitute for a medical consultation.