Sore throat (pharyngitis and tonsillitis)
Also called: sore throat, pharyngitis, tonsillitis, strep throat, throat infection, gala kharab / gale ki kharabi (Urdu)
A sore throat is pain or soreness at the back of the throat (pharyngitis) or in the tonsils (tonsillitis). Most are caused by viruses and get better on their own in about a week. Only some, such as strep throat, need antibiotics.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Pharyngitis means swelling and soreness of the pharynx (the back of the throat). Tonsillitis means the tonsils, the two soft lumps at the back of the mouth, are infected and swollen. Both cause a sore throat and often happen together.
Viruses cause most sore throats at every age, including the viruses of colds, flu and glandular fever (mononucleosis). Bacteria cause fewer. The main one is group A streptococcus (Streptococcus pyogenes), which causes strep throat. It is most common in children aged 5 to 15 years and rare under 3 years. Group A strep causes roughly one in five to three in ten sore throats in children, but only about one in ten or fewer in adults. Sore throats spread easily between family members and other close contacts, through coughs, sneezes and touch.
Most sore throats settle within about a week, often in three or four days, with rest, fluids and simple painkillers. Antibiotics do not help a viral sore throat. For strep throat, antibiotics shorten the illness a little, stop it spreading to others and lower the risk of complications. One rare but serious complication is rheumatic fever, which can damage the heart valves and cause lifelong rheumatic heart disease. This is why a proven strep throat should be treated properly.
In Pakistan: what studies show
Studies in Pakistan found group A strep in 25.3% of sore throats seen by family doctors, yet in one Karachi study 98.5% of adults with sore throat got antibiotics. Rheumatic heart disease, a late result of untreated strep throat, was found in 21.9 per 1,000 school children screened in Lahore.
- In a 2012-2013 study of 5,140 patients with sore throat seen by family doctors in 8 Pakistani cities, 25.3% tested positive for group A strep on a rapid throat test.[1] (cross-sectional, data June 2012 - February 2013)
- In a 2005 study of 137 adults with sore throat at three hospitals in Karachi, 98.5% were given antibiotics.[2] (cross-sectional, data March - October 2005)
- In the same Karachi study, only 4.4% of the adults with sore throat had group A strep on throat culture.[2] (cross-sectional, data March - October 2005)
- A screening study of 24,980 school children aged 5 to 15 in urban and semi-urban Lahore found rheumatic heart disease in 21.9 per 1,000 children.[3] (cross-sectional, data not stated)
- A survey of 9,430 people in rural Rahim Yar Khan district found rheumatic heart disease in 5.7 per 1,000 people.[4] (cross-sectional, data not stated)
- Global Burden of Disease estimates suggest about 1,652,438 people in Pakistan were living with rheumatic heart disease in 2019, up from 705,795 in 1990.[5] (modelled estimate, data 1990-2019)
- The same estimates suggest rheumatic heart disease caused about 21,137 deaths in Pakistan in 2019, up from 15,199 in 1990.[5] (modelled estimate, data 1990-2019)
- An older laboratory study in Sukkur (2001-2003) found 95% of group A strep throat germs from adults were resistant to the antibiotic erythromycin.[6] (cross-sectional, data November 2001 - May 2003)
What we do not know yet: Studies disagree on how often sore throat is due to strep: 25.3% on rapid tests in 8 cities versus 4.4% on culture in one Karachi hospital study. Prescribing and throat-germ resistance data are old (2005 and 2001-2003), there is no recent national resistance data for group A strep, the rheumatic heart disease surveys do not state their study years, and no Pakistan sore throat guideline was found.
Pakistan studies cited
- Rathi SK, Ahmed R. Pakistan prevalence survey in acute pharyngitis. Journal of the Pakistan Medical Association (JPMA) 2014;64(8):928. Open source
- Palla AH, Khan RA, Gilani AH, et al. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulmonary Medicine 2012;12:70. doi:10.1186/1471-2466-12-70. Open source
- Sadiq M, Islam K, Abid R, et al. Prevalence of rheumatic heart disease in school children of urban Lahore. Heart (BMJ) 2009;95(5):353. doi:10.1136/hrt.2008.143982. Open source
- Rizvi SF, Khan MA, Kundi A, et al. Status of rheumatic heart disease in rural Pakistan. Heart (BMJ) 2004;90(4):394-399. doi:10.1136/hrt.2003.025981. PMID 15020513. Open source
- Khan MN, Ahmed B, Majeed H, et al. Thirty years trend of rheumatic heart diseases, Pakistan chapter: insights from the Global Burden of Disease Study. Pakistan Heart Journal 2022;55(3):231-235. doi:10.47144/phj.v55i3.2304. Open source
- Memon BA. Erythromycin resistance in Streptococcus pyogenes Group A throat isolates in Sukkur city. Rawal Medical Journal 2007;32(1):11-13. Open source
Symptoms
- Pain or scratchiness in the throat, often worse when swallowing
- Red, swollen tonsils, sometimes with white patches or pus-filled spots
- Fever (high temperature)
- Painful, swollen glands (lymph nodes) at the front of the neck
- Headache, tiredness, and aching muscles or joints
- Cough, runny nose, hoarse voice or red eyes, which point more to a virus than to strep
- Earache or bad breath
- In children: stomach pain, feeling sick or vomiting, especially with strep throat
- A red rash with strep throat (scarlet fever)
Causes and risk factors
Causes
- Viruses, such as those that cause colds, flu and glandular fever (mononucleosis): the most common cause at all ages
- Group A streptococcus bacteria, which cause strep throat
- Less often, other bacteria, including the sexually transmitted infections gonorrhoea and chlamydia
- Spread by close contact with an infected person, through droplets from coughs and sneezes or unwashed hands
What makes it more likely
- Being a school-age child, especially aged 5 to 15 years, for strep throat
- Close contact with someone who has a sore throat, such as family members
- Being a parent of school-age children or an adult who looks after children
- Crowded places such as schools, day care centres, shelters, prisons and military training camps
- Colder months of the year, when sore throats are more common
- Poverty, overcrowded homes and poor living conditions, which raise the risk of rheumatic fever after strep throat
Complications
Most sore throats get better without problems. Complications are rare and are more likely when strep throat is not treated. The infection can spread to nearby areas and cause a collection of pus behind the tonsil (quinsy, or peritonsillar abscess), a pus collection deeper in the throat (retropharyngeal abscess), infected neck glands or an infected bone behind the ear (mastoiditis). Some weeks after a strep throat, the immune system can wrongly attack the body. This can cause rheumatic fever, which may scar the heart valves and lead to rheumatic heart disease, or a kidney inflammation called post-streptococcal glomerulonephritis. Rheumatic heart disease is the most common heart disease that young people under 25 develop, mostly in poorer countries. Antibiotics taken when not needed can cause diarrhoea and feeling sick, and help germs become resistant.
When to see a doctor
- Difficulty breathing or not being able to swallow: get emergency help now
- A severe sore throat that is getting worse quickly, swelling inside the mouth or throat, trouble speaking, or not being able to open your mouth: these can be signs of quinsy and need urgent care
- Pain so bad that eating or drinking is difficult
- Pus-filled spots on the tonsils, high fever or swollen neck glands, which may be strep throat
- Feeling very unwell, symptoms getting worse fast, or a sore throat that is not better after one week
- Fever with painful joints that move from one joint to another, or jerky movements, some weeks after a sore throat: these can be signs of rheumatic fever
- Sore throats that keep coming back
Diagnosis
A doctor usually diagnoses a sore throat from the symptoms and by looking at the throat and feeling the neck. Signs such as cough, runny nose, hoarse voice and red eyes point to a virus, and these people usually do not need a test. Simple scoring systems help doctors decide who is more likely to have strep throat. FeverPAIN gives a point each for fever, pus on the tonsils, being seen within three days, very swollen tonsils and no cough or cold symptoms. The Centor score uses pus on the tonsils, tender neck glands, fever and no cough.
When strep throat is possible, a throat swab can be tested with a rapid strep test (results in minutes) or a throat culture (a lab test that takes longer and is the most accurate). In children older than 3 years, a negative rapid test may be checked with a culture. A blood test for glandular fever may be done if symptoms are severe or last a long time.
Treatment
- Rest and drink plenty of fluids. Most sore throats get better on their own within about a week.
- Ease pain and fever with paracetamol or, if suitable, ibuprofen. Your doctor or pharmacist decides the dose, especially for children. Do not give aspirin to children under 16.
- Adults may use medicated throat lozenges for short-term pain relief; ask a pharmacist. Do not give lozenges or hard sweets to young children because they can choke.
- Do not take antibiotics for a viral sore throat. They do not help and can cause side effects and resistance.
- If the doctor thinks strep throat is likely, or a strep test is positive, an antibiotic may be prescribed straight away, or a 'back-up' prescription may be given to use only if you are not better in a few days or get worse.
- If you are given an antibiotic, take the full course exactly as prescribed, even when you feel better. This helps clear the infection and protects against rheumatic fever.
- Get help again quickly if you become very unwell or symptoms get worse fast. Severe or repeated tonsillitis may need a specialist; removing the tonsils (tonsillectomy) is only rarely needed.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Pain relievers and fever reducers | first step for pain and fever in all sore throats; paracetamol, or ibuprofen if suitable; do not shorten the illness; doctor or pharmacist decides the dose | Paracetamol (350 brands), Ibuprofen (378 brands) |
| Penicillins | first choice when a doctor confirms or strongly suspects strep throat; amoxicillin by mouth, or a single benzathine penicillin injection given by a health worker; not for viral sore throats | Amoxicillin (248 brands), Benzathine penicillin G (8 brands) |
| Macrolide antibiotics | an option for people allergic to penicillin; erythromycin is preferred in pregnancy if a macrolide is needed; strep can be resistant to this group in some areas | Clarithromycin (489 brands), Erythromycin (11 brands), Azithromycin (662 brands) |
| Cephalosporin antibiotics | an option for strep throat in some people with a mild (not immediate-type) penicillin allergy; the doctor decides | Cephalexin (173 brands) |
| Lincosamide antibiotics | an alternative for strep throat in people with penicillin allergy; resistance occurs in some areas | Clindamycin (42 brands) |
Also used (not yet in our price list): Phenoxymethylpenicillin (penicillin V): the first-choice antibiotic for strep throat in UK and US guidance, Cefadroxil: a cephalosporin option for some people with penicillin allergy, Medicated throat lozenges (with a local anaesthetic, antiseptic or anti-inflammatory): some evidence of short-term pain relief in adults; throat sprays and mouthwashes have little evidence
Self-care and prevention
Self-care
- Rest and drink plenty of cool or warm fluids
- Adults and older children can gargle with warm salt water and spit it out; young children should not gargle
- Suck lozenges or hard sweets (adults and older children only)
- Use a cool-mist humidifier to keep the air moist
- Use paracetamol or ibuprofen for pain, following the label or pharmacist advice
- Stay at home while you are unwell; with strep throat, stay home until the fever has gone and you have been on the antibiotic for at least 12 to 24 hours, as your doctor advises
Prevention
- Wash hands often with soap and water, especially after coughing, sneezing or blowing your nose
- Cover coughs and sneezes with a tissue or your elbow
- Keep children with strep throat home from school until they are fever-free and on antibiotics as the doctor advises
- Get a proven strep throat treated fully, as this prevents rheumatic fever
- People who have had rheumatic fever need regular long-term penicillin injections as advised by their doctor to protect the heart valves
Common questions
Do I need antibiotics for a sore throat?
Usually not. Most sore throats are caused by viruses, and antibiotics do not work against viruses. Antibiotics are needed only for some bacterial infections such as strep throat, which a doctor judges from your symptoms or a throat test. Taking antibiotics when they are not needed can cause side effects and resistance.
How long does a sore throat last?
Most sore throats and tonsillitis get better in three to seven days. See a doctor if you are not better after one week, if it keeps coming back, or if you feel very unwell.
How can I tell if it is strep throat?
Strep throat often starts suddenly with fever, painful swallowing, swollen neck glands and white patches on the tonsils, usually without a cough or runny nose. A cough, runny nose, hoarse voice or red eyes point more to a virus. Only a throat swab test can confirm strep throat.
Why does strep throat matter for the heart?
In some people, especially children, an untreated strep throat can lead weeks later to rheumatic fever, where the immune system damages the heart valves. Repeated attacks can cause rheumatic heart disease. Prompt, complete antibiotic treatment of strep throat helps prevent this.
Is tonsillitis contagious, and when should tonsils be removed?
The viruses and bacteria that cause tonsillitis spread easily, so stay at home while unwell and wash your hands often. Removing the tonsils is rare and is usually considered only when severe tonsillitis keeps coming back.
Sources
- NICE. Sore throat (acute): antimicrobial prescribing (NG84) - visual summary for adults (2023).
- CDC. Clinical Guidance for Group A Streptococcal Pharyngitis (2025).
- WHO. Rheumatic heart disease (fact sheet) (2025).
- NHS. Tonsillitis (2024).
- MedlinePlus. Pharyngitis - sore throat: MedlinePlus Medical Encyclopedia (2025).
- BMC Pulmonary Medicine (Palla AH et al.), Aga Khan University research portal. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study (2012).
- Heart (BMJ) (Rizvi SF et al.). Status of rheumatic heart disease in rural Pakistan (2004).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Common coldInfluenza (flu)SinusitisMiddle ear infection (otitis media)