Penicillin V — the first-line antibiotic for bacterial tonsillitis, and one most sore throats do not need at all.
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Phenoxymethylpenicillin — usually called penicillin V — is the oral form of the original penicillin. It kills bacteria by preventing them building their cell walls.
Its spectrum is deliberately narrow. That narrowness is a virtue, not a limitation: it covers Streptococcus pyogenes, the organism behind bacterial tonsillitis, while leaving most of the rest of the body's bacteria undisturbed. A broader antibiotic would do more collateral damage for no additional benefit.
Group A streptococcus has never developed meaningful resistance to penicillin, which is unusual after eighty years of use and is why it remains first-line.
It is not the right antibiotic for a chest infection, a urine infection, or most skin infections, and it does nothing at all for a virus.
The ten-day course is not about clearing your symptoms — those settle in three or four days. It is about eradicating the organism completely, which reduces the risk of rheumatic fever and post-streptococcal kidney inflammation.
That is why stopping early matters here more than with most antibiotics, and it is worth knowing in advance, because feeling entirely well on day four is exactly when people stop.
A widespread rash appearing when penicillin is given for what turns out to be glandular fever is very common and is not a true allergy. It matters, because being labelled penicillin-allergic on that basis follows people for decades and pushes them onto broader, less suitable antibiotics for the rest of their lives.
Care with significant kidney impairment, where the dose may need adjusting.
Around one in ten people carry a penicillin allergy label and the large majority of them are not truly allergic. Childhood rashes during viral illness account for most of it.
That label has real consequences — broader antibiotics, more side effects, worse outcomes. If yours came from a vague childhood rash rather than a documented reaction, it is genuinely worth getting properly assessed.
Considered safe in pregnancy and breastfeeding.
No routine monitoring is needed for a standard ten-day course.
Antibiotics do not reduce the effectiveness of the contraceptive pill, other than the specific enzyme-inducing ones — which penicillin is not. This advice changed years ago and is still widely repeated in its old form. If vomiting or diarrhoea occurs, that is a reason for extra precautions, not the antibiotic itself.
Yes, where the assessment genuinely supports a bacterial throat infection. That assessment is the substance of the consultation, because most sore throats are viral and antibiotics do nothing for them.
What we use to judge it is the FeverPAIN or Centor scoring — fever, pus on the tonsils, absence of cough, tender neck glands, and how quickly it came on. A high score makes streptococcal infection likely enough to treat; a low one makes it unlikely enough not to.
Photographs of the throat help, taken in good light with a phone torch.
What we will not do is issue penicillin for every sore throat on request. That is not caution for its own sake — unnecessary antibiotics cause side effects, thrush and resistance, and they do not shorten a viral illness by a single day.
What needs urgent in-person care: difficulty breathing or swallowing saliva, a muffled voice, inability to open the mouth fully, or severe one-sided pain — all of which suggest quinsy and need same-day hospital assessment rather than a prescription.
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Phenoxymethylpenicillin is one of the cheapest antibiotics available. A ten-day course on a private prescription typically costs less than the England NHS prescription charge. NHS prescriptions are free in Wales.
It comes as tablets and as a liquid for children. The liquid tastes unpleasant, which is a genuine practical obstacle over ten days — worth planning for rather than discovering on day two.
For a sore throat, regular paracetamol and ibuprofen do more for how you feel than an antibiotic does, even when the infection is bacterial. Salt water gargles, cold drinks and ice lollies are genuinely useful.
Difflam spray and medicated lozenges are available over the counter and provide real relief.
Complete the full ten days. This is the course where finishing matters most, because the aim extends beyond your symptoms to eradicating the organism and avoiding rheumatic fever.
You will feel well by day three or four. Keep going.
Probably not. The large majority of sore throats are viral, and antibiotics neither shorten them nor prevent complications in that setting.
What shifts the balance is fever, pus on the tonsils, tender neck glands and the absence of a cough — together those make streptococcal infection likely enough to treat.
Because the goal is eradicating the organism, not just settling your symptoms. Ten days is what reliably clears streptococcus and reduces the small risk of rheumatic fever afterwards.
Better not to. An hour before eating or two hours after. Food reduces how much is absorbed, which is a common reason a course seems less effective than expected.
No. This advice changed years ago but is still repeated. Ordinary antibiotics do not reduce the pill's effectiveness — only specific enzyme-inducing drugs do, and penicillin is not one.
Vomiting or diarrhoea is a different matter and does warrant extra precautions.
Quite possibly not. Most childhood penicillin allergy labels come from a rash during a viral illness, and the majority of people carrying one turn out not to be allergic when tested.
It is worth getting assessed, because the label pushes you onto broader antibiotics for life.
Yes — alcohol does not interact with penicillin. It will not help you feel better, but it does not undo the treatment.
Generally 24 hours after starting the antibiotic, once the fever has settled.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 5, 2026
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