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.

Do I need antibiotics for a sore throat?

• Strep A bacteria cause around 5% to 15% of sore throats in adults and 20% to 30% in children, according to the US Centers for Disease Control and Prevention (CDC).
• In a Cochrane review of 29 trials covering 15,337 sore throat cases, antibiotics shortened symptoms by about 16 hours on average.
• England recorded 2,535 notifications of invasive strep A infection in the 2025 to 2026 season, above the five-season average of 2,260, according to UKHSA's final season report of 24 September 2026.
• Scarlet fever usually peaks in late winter and spring. Last season, GP consultations for scarlet fever peaked in March at 1.34 per 100,000 people.
• Rhinovirus, a common cold virus, was the most frequently detected respiratory virus in laboratory tests in the week to 11 October 2026, at 18.1%, according to UKHSA.

How long does a sore throat usually last?

Most sore throats get better within about a week, whether they are caused by a virus or by bacteria. A cold, cough or runny nose alongside a sore throat makes a viral cause more likely. Cold viruses are circulating widely now. Rhinovirus was the most common respiratory virus in laboratory tests in the week to 11 October 2026, at 18.1%, according to the UKHSA surveillance report of 15 October 2026. Pain relief, fluids and rest are usually all that is needed, and antibiotics will not help a viral infection.

A sore throat lasting more than a week, one that is getting worse, or one with a high temperature and swollen tonsils is worth a doctor's assessment.

Is my sore throat viral or bacterial?

You cannot be certain from symptoms alone, and a look at the tonsils may not settle it. A cough or runny nose alongside the pain makes a viral illness more likely. Doctors use scoring tools such as FeverPAIN, developed by researchers at the University of Southampton and recommended by NICE guideline NG84, which give one point for each of these five features.

1. Fever in the past 24 hours.
2. Pus or white patches on the tonsils.
3. Attending quickly, within three days of the sore throat starting.
4. Very inflamed, swollen tonsils.
5. No cough and no runny or blocked nose.

A higher score makes a bacterial infection more likely and antibiotics more likely to help. 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. A low score, especially with a cough, runny nose or hoarse voice, points to a virus. Other illnesses, including glandular fever, can give a very sore throat and swollen glands. On a video call the doctor can check most of these signs by looking at your throat with your phone torch.

Show a doctor your throat on a video call today.

Do antibiotics help a sore throat?

Antibiotics help some sore throats, but the benefit is modest for most people. In a Cochrane review of 29 trials covering 15,337 cases, antibiotics reduced the proportion with a sore throat at day three (risk ratio 0.70). They did not significantly reduce fever at day three. NICE explains that symptoms are shortened by about 16 hours on average.

• About 6 people needed antibiotics for one extra person to be free of a sore throat by day three.
• By one week, about 18 people needed treatment for one extra person to benefit.
• Antibiotics reduced complications such as ear infections, quinsy and rheumatic fever, but these complications are uncommon in the UK.

Antibiotics also carry side effects, such as stomach upset, thrush and rashes, and each course adds to antibiotic resistance. This is why a doctor recommends them when a bacterial infection is likely, rather than for every sore throat. Do not take someone else's antibiotics or a leftover course.

What is strep A, and how is it different from scarlet fever?

Strep A, or group A streptococcus, is a common bacterium that causes strep throat and tonsillitis. Scarlet fever is a strep A infection with a characteristic rash. It is most common in children, but adults can catch it, and it is treated with antibiotics.

According to UKHSA's September 2026 guide to scarlet fever, the symptoms are these.

1. Sore throat, fever, headache, nausea and vomiting, which often come first.
2. A rough, sandpaper-like rash 12 to 48 hours later, usually starting on the chest or tummy.
3. Flushed cheeks and swollen glands in the neck.
4. A white coating on the tongue that peels to leave a red, swollen strawberry tongue.
5. Peeling skin on the fingertips and toes as the rash fades.

Scarlet fever is usually treated with a 10-day course of antibiotics, and UKHSA stresses that it is essential to finish the course. Children and adults should stay away from nursery, school or work until at least 24 hours after starting antibiotics. Our guide to the scarlet fever rash, antibiotics and school rules covers the return-to-school detail.

How common is strep A in England?

Invasive strep A, the rare serious form, was higher than average last season. England recorded 2,535 notifications in the 2025 to 2026 season, compared with a five-season average of 2,260, according to the UKHSA final season report of 24 September 2026.

• Rates of invasive strep A were highest in people aged 75 and over, at 15.7 per 100,000, and babies under 1, at 7.1 per 100,000.
• Scarlet fever followed its usual pattern, peaking in March 2026 at 1.34 GP consultations per 100,000 people.
• By mid-September 2026, scarlet fever was back to normal low levels for the time of year.

Most strep A infections are mild and respond well to treatment. The season is only beginning, so it is worth knowing the symptoms through the winter, especially if you have young children.

Can an online doctor diagnose tonsillitis or strep throat?

Yes. A doctor can assess symptoms of a sore throat by video, asking about your symptoms and looking at your throat and tonsils with your phone torch. Video alone cannot reliably confirm strep A; a swab or rapid test may be needed. They can then advise on self-care, prescribe antibiotics where a bacterial infection is likely, or recommend a throat swab or an in-person examination if the picture is unclear.

A telephone consultation also works for adults with mild symptoms who want advice. For children, very swollen tonsils or suspected scarlet fever, video is the better choice because the doctor needs to see the throat and the rash. Our guide to choosing a phone or video GP appointment explains the difference.

Book a video GP for a sore throat on WhatsApp.

What can I do at home for a sore throat?

Most sore throats can be managed at home while your body clears the infection. These steps ease the pain and help you stay comfortable.

1. Take paracetamol or ibuprofen, following the dose on the packet, if safe for you.
2. Drink plenty of fluids, and try cool drinks, ice lollies or warm honey and lemon.
3. Adults can gargle with warm salt water. Children should not try this.
4. Use lozenges or throat sprays from a pharmacy. These ease symptoms but do not treat the cause.
5. Rest, and avoid smoking and smoky places.

A pharmacist can also assess a sore throat. Many pharmacies in England can examine people aged 5 and over and supply treatment where needed.

When is a sore throat an emergency?

Call 999 or go to the nearest emergency department if someone with a sore throat has difficulty breathing, makes a high-pitched noise when breathing in, is drooling or cannot swallow their own saliva, or has a rash that does not fade when you press a glass against it. A child who is floppy, very drowsy or hard to wake also needs emergency care. If you are very unwell, immunosuppressed, or dehydrated because swallowing is too painful, seek prompt medical assessment.

Get a same-day doctor's assessment for severe pain on one side of the throat with difficulty opening the mouth or a muffled voice, which can be a sign of quinsy, an abscess next to the tonsil.

When should I see a doctor about a sore throat?

You should see a doctor if your sore throat has not improved after a week, if it is severe, or if you have a high temperature with swollen tonsils. You should also see a doctor if you think you or your child has scarlet fever, if your immune system is weakened, or if you keep getting sore throats.

At a private GP visit, the doctor 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 score, decide whether no prescription, a back-up prescription or treatment now is justified, and set out what should trigger another review.

If your sore throat comes with a high temperature, aches and a cough, it may be flu or COVID. Our guide to flu symptoms and when to see a doctor explains what to do in the first 48 hours.

See a doctor about your sore throat today on WhatsApp.

How much does it cost to see a private GP about a sore throat?

At The Online GP by The Wellness, a telephone consultation costs £59 for up to 15 minutes and a 30-minute video consultation costs from £150, and in-person appointment fees in Marylebone are confirmed before booking. If antibiotics are needed, the prescription is issued during the consultation and sent to a pharmacy near you, and the pharmacy charges separately for the medicine. Home visits across London cost £450, and hotel visits cost £495 by day or £595 in the evening for anyone too unwell to travel.

The value of the appointment is the clinical judgement about when medicine is useful and when it is not. Book a telephone appointment or an in-person appointment.

Can a doctor tell me if my sore throat needs to be seen?

Yes. The Online GP by The Wellness offers a free suitability review. Send your symptoms, how long you have had them and the age of the person who is unwell on WhatsApp. A doctor tells you whether a call or a video consultation suits you, or tells you plainly if a pharmacist or self-care is the right step.

Start your free suitability review on WhatsApp.

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.

Can I get antibiotics online for a sore throat?

Yes. A GMC-registered doctor can prescribe antibiotics after a phone or video consultation when a bacterial infection such as strep A is likely. Many sore throats are viral, and the doctor will explain when antibiotics will not help.

How do I know if my sore throat is strep?

Strep is more likely with fever, pus on the tonsils, very swollen tonsils and no cough or runny nose. A doctor can assess these by video and decide whether antibiotics or a throat swab are needed.

Is scarlet fever contagious?

Yes. Scarlet fever spreads through coughs, sneezes and close contact. Children and adults should stay away from nursery, school or work until at least 24 hours after starting antibiotics.

Can a doctor look at my child's throat by video?

Yes. With a phone torch and good light, a doctor can see a child's throat, tongue and any rash on video. A parent or guardian needs to be present.

How long is someone with strep throat contagious?

People with strep throat are much less likely to spread it once they have taken antibiotics for 24 hours, which is why that is the point at which they can usually return to school or work.

Is a sore throat a symptom of flu or COVID?

Yes. A sore throat is common with flu, COVID and colds. A high temperature, body aches and tiredness alongside it point towards flu or COVID rather than strep A.

When should I go to A&E with a sore throat?

Difficulty breathing, inability to swallow your own saliva, drooling, a high-pitched breathing noise, or a rash that does not fade under a pressed glass needs emergency help rather than a routine GP appointment.

General information, not a personal diagnosis. Written by The Wellness Team and reviewed by The Wellness Clinical Team. Last reviewed 22 October 2026.

Sources

• NICE guideline NG84, sore throat (acute): antimicrobial prescribing
• UKHSA, Group A streptococcal infections, fourth and final update report on seasonal activity in England, 2025 to 2026, 24 September 2026
• UKHSA, What are the symptoms of scarlet fever and is it contagious, 21 September 2026
• UKHSA, National flu and COVID-19 surveillance report, 15 October 2026, week 42
• Spinks A, Glasziou PP, Del Mar CB, Antibiotics for sore throat, Cochrane Database of Systematic Reviews, 2021
• CDC, Clinical guidance for group A streptococcal pharyngitis
• Little P et al, FeverPAIN clinical score for sore throat, BMJ, 2013
• NHS, sore throat advice