Most are viral and settle in a week. A scoring system tells us which are not.
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Most sore throats are viral, last about a week, and get better without antibiotics. That is genuinely the whole story for the large majority — and antibiotics shorten a bacterial sore throat by around a day at best.
But this page carries several things that matter far more than the average sore throat, because they are the ones that get missed.
The emergency signs — all about swallowing and breathing, not pain: difficulty swallowing your own saliva or drooling, difficulty opening your mouth, a muffled "hot potato" voice, noisy breathing, or a swollen neck. These suggest a quinsy or a deep infection blocking the airway, and they need immediate assessment — not a video call.
The one that saves lives and is rarely stated: if you take carbimazole, methotrexate, clozapine, or another immune-suppressing drug, a sore throat with fever needs an urgent blood count the same day. These drugs can occasionally wipe out the white cells that fight infection, and a sore throat is often the first sign. Say what you take, immediately.
And the three-week rule: a sore throat lasting more than three weeks — particularly with hoarseness, in a smoker or drinker — needs a specialist look, not another antibiotic.
Genuinely useful, because it predicts whether antibiotics will help:
Worth suspecting in teenagers and young adults with a sore throat that is dragging on well beyond a week:
Common cold viruses, influenza, COVID, and adenovirus. Glandular fever (Epstein-Barr virus) is an important cause in teenagers and young adults.
Group A streptococcus is the main one — more common in children, and the cause of scarlet fever. Less commonly, other bacteria, and rarely gonorrhoea in the throat, which is worth considering after oral sex and which produces no symptoms in most people who have it.
Agranulocytosis — a sudden loss of infection-fighting white cells, which can be caused by carbimazole, methotrexate, clozapine, some DMARDs and chemotherapy. It typically announces itself as a sore throat with fever, and it needs an urgent full blood count the same day. Rare, treatable if caught, dangerous if not — and easily mistaken for an ordinary sore throat.
Head and neck cancer can present as a persistent sore throat, particularly with hoarseness, a neck lump, difficulty swallowing or one-sided ear pain — and particularly in smokers and heavy drinkers. Three weeks is the threshold for referral, not three months.
Sore throat is assessed from the history, and a video consultation covers most of it — including looking at the throat, which you can show us.
We use FeverPAIN or Centor — structured scores based on fever, pus, rapid onset, inflamed tonsils and absence of cough. They are not perfect, but they turn a guess into a defensible decision about antibiotics, and they are what stops both over-prescribing and under-treating.
Anyone who cannot swallow saliva, is drooling, cannot open their mouth, has a muffled voice, noisy breathing or neck swelling. These need immediate face-to-face assessment — usually A&E — and we will say so straight away rather than arranging anything else.
Most sore throats do not need them. Where the score suggests streptococcal infection, or where someone is significantly unwell, immunosuppressed or deteriorating, penicillin V for a full ten days is standard — the longer course matters for streptococcal infection.
A back-up prescription — to hold and use only if things are not improving in a few days — is often the sensible middle path.
Do not take amoxicillin or ampicillin if glandular fever is possible. It causes a widespread, dramatic rash in the great majority of people with glandular fever — alarming, uncomfortable, and frequently misrecorded as a lifelong penicillin allergy that then limits antibiotic choices for years.
A single dose of an oral steroid can help severe pain in adults where swallowing is difficult, alongside other treatment. Used selectively rather than routinely.
Where the throat has been sore for weeks, the answer is usually not an antibiotic: reflux treatment, nasal steroid spray for post-nasal drip, rinsing the mouth after inhaled steroids, humidifying the bedroom, and stopping smoking.
Call 999 or go to A&E for:
Seek same-day medical advice for:
Book an appointment for:
Wash hands, use tissues, do not share cups or cutlery. For streptococcal infection, stay off school or work until 24 hours after starting antibiotics. For an ordinary viral sore throat, go back when you feel well enough.
Most sore throats are viral, settle in a week, and need no antibiotic. Paracetamol and ibuprofen taken regularly do more for how you feel than anything a prescription offers — including when the infection is bacterial. Difflam spray, medicated lozenges, salt water gargles and ice lollies all genuinely help and cost very little.
Pharmacies now assess and treat sore throat through Pharmacy First, free and without an appointment, using the same FeverPAIN scoring a GP would. That is the right first stop and we would send you there rather than charge you.
Where a private consultation is worth it is when you need certainty quickly — an important commitment, a pattern of recurrent tonsillitis you want documented, or genuine uncertainty about whether this is more than a sore throat.
Documenting recurrent episodes matters more than people realise. NHS tonsillectomy criteria are based on the number of documented episodes over one to two years, and undocumented episodes do not count. If you get tonsillitis repeatedly, having each one recorded is what eventually makes the case for surgery.
What needs urgent in-person care: difficulty breathing or swallowing your own saliva, a muffled voice, drooling, or inability to open your mouth fully — which suggest quinsy and need same-day hospital assessment.
NICE NG84, Sore throat (acute): antimicrobial prescribing, is the governing guideline. It recommends no antibiotic or a back-up prescription for most people, since sore throat is usually self-limiting, and the use of FeverPAIN or Centor scoring to identify the minority likely to have streptococcal infection.
NG84 recommends phenoxymethylpenicillin for 5 to 10 days where an antibiotic is indicated, with clarithromycin or erythromycin in penicillin allergy — the basis for what this page says about treatment.
NICE Clinical Knowledge Summary, Sore throat — acute, covers assessment, self-care and the complications warranting same-day referral, including peritonsillar abscess.
The NHS Pharmacy First clinical pathway for acute sore throat applies FeverPAIN in community pharmacy for people aged 5 and over, which is why this page directs there.
ENT UK and commissioning guidance for tonsillectomy set the documented-episode thresholds referenced above.
Usually not. Most sore throats are viral, and even for a streptococcal one antibiotics shorten it by around a day. Cough, a runny nose and hoarseness all point towards a virus. Fever, pus on the tonsils, tender neck glands and no cough point the other way — and that is when we would consider them, or offer a back-up prescription to use only if you are not improving.
They are about swallowing and breathing, not how much it hurts. Difficulty swallowing your own saliva or drooling, difficulty opening your mouth, a muffled voice, noisy breathing, or a swollen neck. These suggest a quinsy or a deep neck infection that can threaten the airway, and they need to be seen straight away.
You need a full blood count today. Methotrexate, carbimazole, clozapine and similar drugs can occasionally cause a sudden drop in infection-fighting white cells, and a sore throat with fever is often the first sign. It is uncommon, treatable when caught, and dangerous when missed. Tell whoever you speak to what you take, before anything else.
Because it causes a widespread, dramatic rash in the great majority of people who have glandular fever. It is not dangerous, but it is alarming, uncomfortable, and frequently misrecorded as a lifelong penicillin allergy — which then narrows the antibiotic options available to you for the rest of your life.
About a week for most, and tonsillitis a similar length. Beyond three weeks it needs a specialist look — particularly with hoarseness, a neck lump or one-sided ear pain, and particularly in smokers and heavy drinkers. That is the threshold for referral, and it is worth taking seriously.
Then it is probably not infection. The commonest causes are acid reflux — which often causes throat soreness, hoarseness and throat clearing with no heartburn at all — post-nasal drip, mouth breathing at night, smoking, and steroid inhalers used without rinsing the mouth afterwards. All treatable, and none of them helped by antibiotics.
For an ordinary viral sore throat, when you feel well enough. For confirmed streptococcal infection or scarlet fever, 24 hours after starting antibiotics. For glandular fever, when the fatigue allows — but avoid contact sport and heavy lifting for at least four to six weeks because of the risk to an enlarged spleen.
Only for genuinely frequent, well-documented episodes — broadly seven in a year, five a year for two years, or three a year for three years — or after a quinsy or where breathing at night is affected. Keeping a record of dates and treatments is what makes that conversation possible, since referral depends on documented frequency rather than recollection.
August 23, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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