Conjunctivitis & Stye
Cough – myth busting
Common cold and flu are viral illnesses affecting the upper respiratory tract causing blocked and runny nose, sneezing, sore throat, coughing and sometimes temperatures, headaches and muscle aches.
Adults can expect 2-4 colds a year, while nursery age children can have up to 12 a year, each lasting for up to two weeks. It feels like they are always ill.
Most people know how to treat themselves by resting, drinking fluids and using over the counter medication to ease the symptoms.
Cough Information Video
Red Flags
However there are some “red flags” that could be signs of serious underlying illness and might need medical intervention. If you have these symptoms, please seek medical attention promptly. The reg flags for cough are:
– SHORTNESS OF BREATH (meaning that you are breathless when not coughing)
– COUGHING UP BLOOD (especially if is is not only a few specks of blood mixed with mucus)
– FEVER FOR LONGER THAN 5 DAYS (higher than 38.5 at least once a day)
– CHEST PAIN ON THE SIDE (especially if it is worse on breathing in)
– UNDERLYING ILLNESS (mainly asthma, COPD, weak immune system, frail, elderly)
NB: an elderly person with temperature always needs to be seen ASAP, regardless of any other symptoms
– COUGH LASTING LONGER THAN 6 WEEKS
There are some common myths that we GPs still come across with in consultations. Let’s disperse them:
Paracetamol and ibuprofen are needed to treat respiratory infections with fever.
Mums often call us panicking that their child’s temperature is high with a respiratory tract infection, but they refuse to take medicine like Calpol or Nurofen. Please don’t panic, the temperature has the tendency to go up and then to come down on its own. If we know that the illness is a viral upper respiratory tract infection, we don’t need to worry about the temperature, it is part of the immune response. Calpol and Neurophen are not known to shorten the illness duration or reduce hospital admission rate. They just make the child feel a little bit less poorly. If your child refuses, you don’t need to force them to take the medicine, they will get better regardless. We have a separate chapter on high temperature, you might want to check that one out.
Cold and flu last only for a couple of days.
Patients call us saying that they are better from the initial temperature, but after 5 (or 7 or 10) days they still have the cough. This is quite normal. It is the temperature that settles first, then you feel better in yourself, but the cough can linger around for up to 3 weeks because this is how long it takes for the airway lining to recover. Please contact your GP if the cough lasts longer than 6 weeks, you need to be investigated.
Similarly, a real flu can make you ill and pin you to bed for a good two weeks before you get better. Unfortunately there is no quick fix for that, just take the time and rest if you don’t have the any of red flags we discussed above.
Coughing up green mucus is a sign of bacterial infection.
You might start with a dry cough that changes to phlegmy, chesty cough with different colours of sputum, before it resolves. If there is no underlying lung condition like COPD, the colour or the mucus is not an indication of a bacterial infection.
Your GP is not mean by not giving you the antibiotics, it simply does not work. Antibiotics are not “let’s try anyway” or “I want to get better sooner as I am fed up with this cough” or “I need to go back to work, give me something strong” type of medication as we used to look at them. We need to change this view and see antibiotics as life saving drugs that are very precious and preserved for serious bacterial infections. Otherwise we lose them all soon.
With cold and flu I need to take cough medicine.
Cough medicine for young children contains no active ingredients, most times they are just sweet syrups with or without glycerol that can moisturise the throat when swallowed. However the cough is coming mainly from the deeper level of the throat, so the medicine helps only for a few minutes or not at all. Cough syrups for older children and for adults might contain cough suppressants. They are marketed for dry cough and can work to some extent, however most times the viral infection causes a chesty cough with mucus that needs to clear, so suppressing the cough is not a good idea. It is a defence mechanism stopping the infection spreading deeper. Cough is tough, but it is useful.
Using ibuprofen is better than paracetamol as it is an anti inflammatory.
There is no evidence that ibuprofen would be more effective than paracetamol, but some people might find that one or the other works better for them.
Steam inhalation shortens the disease.
I would love to say this is the case, as patients often hear this advice from us, but unfortunately there is no evidence that steam inhalation makes you better quicker, but it might provide symptom relief temporarily.
My throat is so sore that I need antibiotics.
Sore throat is one the worst symptoms of an upper respiratory tract infection. I can’t blame you for wanting to get it fixed ASAP. Antibiotics seem to be the quick fix, as if they work, they work pretty quickly, within 24-48 hours. However, antibiotics only work for bacteria, not for viruses. The level of pain is not an indication of the nature of the infection. You can have pain like razor blades from a viral infection. To see the signs and symptoms of a bacterial throat infection, when you might benefit from antibiotics, please check out our “tonsillitis” chapter.
If it spreads to the chest I will need antibiotics.
Yes, it can happen that the virus spreads on the chest, causing inflammation of the lining of the lower airways, called bronchitis. The bronchitis cough can cause pain behind the breastbone and with bronchitis, you feel more poorly compared to a simple cold. Also it could last longer. However most of the time this is still the very same virus that has given you the cold, and antibiotics still would not work against it.
There is a separate topic about “chest infection”, if you are worried about that possibility, please check that chapter out.
For further information, please consider visiting:
– https://www.nhs.uk/conditions/cough/
– https://www.nhs.uk/conditions/common-cold/
– https://patient.info/chest-lungs/cough-leaflet/common-cold-upper-respiratory-tract-infections
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/
– https://www.bmj.com/content/347/bmj.f6041
Adults can expect 2-4 colds a year, while nursery age children can have up to 12 a year, each lasting for up to two weeks. It feels like they are always ill.
Most people know how to treat themselves by resting, drinking fluids and using over the counter medication to ease the symptoms.
Cough Information Video
Red Flags
However there are some “red flags” that could be signs of serious underlying illness and might need medical intervention. If you have these symptoms, please seek medical attention promptly. The reg flags for cough are:
– SHORTNESS OF BREATH (meaning that you are breathless when not coughing)
– COUGHING UP BLOOD (especially if is is not only a few specks of blood mixed with mucus)
– FEVER FOR LONGER THAN 5 DAYS (higher than 38.5 at least once a day)
– CHEST PAIN ON THE SIDE (especially if it is worse on breathing in)
– UNDERLYING ILLNESS (mainly asthma, COPD, weak immune system, frail, elderly)
NB: an elderly person with temperature always needs to be seen ASAP, regardless of any other symptoms
– COUGH LASTING LONGER THAN 6 WEEKS
There are some common myths that we GPs still come across with in consultations. Let’s disperse them:
Paracetamol and ibuprofen are needed to treat respiratory infections with fever.
Mums often call us panicking that their child’s temperature is high with a respiratory tract infection, but they refuse to take medicine like Calpol or Nurofen. Please don’t panic, the temperature has the tendency to go up and then to come down on its own. If we know that the illness is a viral upper respiratory tract infection, we don’t need to worry about the temperature, it is part of the immune response. Calpol and Neurophen are not known to shorten the illness duration or reduce hospital admission rate. They just make the child feel a little bit less poorly. If your child refuses, you don’t need to force them to take the medicine, they will get better regardless. We have a separate chapter on high temperature, you might want to check that one out.
Cold and flu last only for a couple of days.
Patients call us saying that they are better from the initial temperature, but after 5 (or 7 or 10) days they still have the cough. This is quite normal. It is the temperature that settles first, then you feel better in yourself, but the cough can linger around for up to 3 weeks because this is how long it takes for the airway lining to recover. Please contact your GP if the cough lasts longer than 6 weeks, you need to be investigated.
Similarly, a real flu can make you ill and pin you to bed for a good two weeks before you get better. Unfortunately there is no quick fix for that, just take the time and rest if you don’t have the any of red flags we discussed above.
Coughing up green mucus is a sign of bacterial infection.
You might start with a dry cough that changes to phlegmy, chesty cough with different colours of sputum, before it resolves. If there is no underlying lung condition like COPD, the colour or the mucus is not an indication of a bacterial infection.
Your GP is not mean by not giving you the antibiotics, it simply does not work. Antibiotics are not “let’s try anyway” or “I want to get better sooner as I am fed up with this cough” or “I need to go back to work, give me something strong” type of medication as we used to look at them. We need to change this view and see antibiotics as life saving drugs that are very precious and preserved for serious bacterial infections. Otherwise we lose them all soon.
With cold and flu I need to take cough medicine.
Cough medicine for young children contains no active ingredients, most times they are just sweet syrups with or without glycerol that can moisturise the throat when swallowed. However the cough is coming mainly from the deeper level of the throat, so the medicine helps only for a few minutes or not at all. Cough syrups for older children and for adults might contain cough suppressants. They are marketed for dry cough and can work to some extent, however most times the viral infection causes a chesty cough with mucus that needs to clear, so suppressing the cough is not a good idea. It is a defence mechanism stopping the infection spreading deeper. Cough is tough, but it is useful.
Using ibuprofen is better than paracetamol as it is an anti inflammatory.
There is no evidence that ibuprofen would be more effective than paracetamol, but some people might find that one or the other works better for them.
Steam inhalation shortens the disease.
I would love to say this is the case, as patients often hear this advice from us, but unfortunately there is no evidence that steam inhalation makes you better quicker, but it might provide symptom relief temporarily.
My throat is so sore that I need antibiotics.
Sore throat is one the worst symptoms of an upper respiratory tract infection. I can’t blame you for wanting to get it fixed ASAP. Antibiotics seem to be the quick fix, as if they work, they work pretty quickly, within 24-48 hours. However, antibiotics only work for bacteria, not for viruses. The level of pain is not an indication of the nature of the infection. You can have pain like razor blades from a viral infection. To see the signs and symptoms of a bacterial throat infection, when you might benefit from antibiotics, please check out our “tonsillitis” chapter.
If it spreads to the chest I will need antibiotics.
Yes, it can happen that the virus spreads on the chest, causing inflammation of the lining of the lower airways, called bronchitis. The bronchitis cough can cause pain behind the breastbone and with bronchitis, you feel more poorly compared to a simple cold. Also it could last longer. However most of the time this is still the very same virus that has given you the cold, and antibiotics still would not work against it.
There is a separate topic about “chest infection”, if you are worried about that possibility, please check that chapter out.
For further information, please consider visiting:
– https://www.nhs.uk/conditions/cough/
– https://www.nhs.uk/conditions/common-cold/
– https://patient.info/chest-lungs/cough-leaflet/common-cold-upper-respiratory-tract-infections
– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410464/
– https://www.bmj.com/content/347/bmj.f6041
Chest infection
Infection of the lower airways. The two types of it are bronchitis and pneumonia.
Bronchitis is the inflammation of the tubes while pneumonia is the inflammation of the very small tubes and the air sacs of the lung called alveoli.
In lay language both of these could be called “chest infection” however the two conditions are very different in terms of how worried we need to be about them.
(Pleurisy is another commonly used term referring to sharp localised chest pain that is worse on deep breathing. This is sometimes related to chest infection, but could have other causes that are beyond the scope of this summary.)
Chest Infection Information Video
Experts agree that symptomatic treatments are the mainstay of treatment for acute bronchitis [Kinkade and Long, 2016; BMJ Best Practice, 2018; MQIC, 2018].
To treat the cough some people may wish to try the following self-care treatments:
– Honey
– Pelargonium (a herbal medicine)
– Over-the-counter cough medicines containing guaifenesin (an expectorant)
– Over-the-counter cough medicines containing cough suppressants (except codeine) if the person does not have a persistent cough or excessive secretions
In the guideline Cough (acute): antimicrobial prescribing, the NICE committee acknowledged the limited evidence on self-care treatment, but noted that promoting self care may have a role in reducing antibiotic prescriptions and general practice consultations [NICE, 2019b].
Bronchitis is the inflammation of the tubes while pneumonia is the inflammation of the very small tubes and the air sacs of the lung called alveoli.
In lay language both of these could be called “chest infection” however the two conditions are very different in terms of how worried we need to be about them.
(Pleurisy is another commonly used term referring to sharp localised chest pain that is worse on deep breathing. This is sometimes related to chest infection, but could have other causes that are beyond the scope of this summary.)
Chest Infection Information Video
Experts agree that symptomatic treatments are the mainstay of treatment for acute bronchitis [Kinkade and Long, 2016; BMJ Best Practice, 2018; MQIC, 2018].
To treat the cough some people may wish to try the following self-care treatments:
– Honey
– Pelargonium (a herbal medicine)
– Over-the-counter cough medicines containing guaifenesin (an expectorant)
– Over-the-counter cough medicines containing cough suppressants (except codeine) if the person does not have a persistent cough or excessive secretions
In the guideline Cough (acute): antimicrobial prescribing, the NICE committee acknowledged the limited evidence on self-care treatment, but noted that promoting self care may have a role in reducing antibiotic prescriptions and general practice consultations [NICE, 2019b].
Diarrhoea – vomiting, loose/watery stools, tummy bug, gastroenteritis, food poisoning
Infection of the guts by virus or bacteria can cause vomiting and / or diarrhoea. Usually vomiting starts first then the diarrhoea comes, but you might have one or the other only.
Most times the infection settles without medication regardless if it is a bug or food poisoning. Antibiotics are not needed.
Vomiting lasts for 1-3 days average and diarrhoea lasts for 3-7 days average.
You will feel rough and unwell for the first few days with stomach cramps coming and going, no appetite and you might have temperature. Take rest.
Call the practice if:
1. if there is blood mixed with your stools. This could be a sign of a more violent bug and you might need medical treatment, especially if you are returning from tropical areas.
If you vomit violently you might see streaks or specs of blood in the vomit or the mucus you bring up, this is normally harmless. If there is more than that of blood, seek medical attention.
2. if you don’t pass urine at least twice in 24 hours (or less than 2 wet nappies in 24 hours), as you could be dehydrated.
3. if your stomach pain is severe and continuous for longer than 4 hours without breaks.
4. if you have temperature above 38.5 for longer than 3 days (it is always a good idea to have a working thermometer at home).
5. if the diarrhoea lasts for longer than 2 weeks and not improving as your doctor might want to arrange a stool sample.
6. if you are in ill health with kidney, heart or endocrine disease, or you are on certain medication that might need to be stopped or increased during an acute illness.
7. if you have severe diarrhoea with or after an antibiotic course (risk of C.difficile infection).
Advice
Do sip water between vomiting episodes even if you feel it all comes back, some will get absorbed. Once you can tolerate water well, drink pressed 100% apple juice diluted half-and-half with water to replace the minerals you have lost. You can choose to drink oral rehydration fluids, like Dioralyte, but the taste might put you off, apple juice is just as good.
Avoid squash that contains artificial sweeteners.
Continue breastfeeding your baby on demand or offer formula milk as normal.
If your child (over the age of 6 months) refuses to drink and you are concerned about them getting dehydrated, you can administer water or other fluids via a syringe (like the ones that come with medication) directly to the child’s mouth. Try 5-10ml every 10 minutes and record it on a chart. This is what nurses do in the hospital to avoid the need for an IV drip.
Only eat when you are hungry, do not force yourself. Your appetite is gone as your guts are inflamed and not ready to digest food. Give them a break to recover. Not eating for a few days is not harmful for your or your child’s body, just carry on drinking.
When you are hungry again only eat small amounts of very bland food, like white toast with jam, no butter; cooked rice, cooked potato, apple, bananas, clear vegetable or chicken soup. Avoid meat, dairy, fibres and fat until your stools are normal again. Otherwise you risk another diarrhoea episode.
Do take paracetamol and Buscopan if you need relief from pain and cramps. These medications do not cure you or shorten the disease but provide symptom relief. Absorbents, like Smecta, might shorten the diarrhoea duration (by half to one day), available without prescription.
The use of Imodium (loperamide) is controversial, several studies showed safety and efficacy, however we GPs still advise against it.
Do wash your hands regularly especially after toileting and before meals.
Children can return to school 48 hours after the last diarrhoea or vomiting episode.
Further advice:
https://www.nhs.uk/conditions/diarrhoea-and-vomiting/
Health protection in children and young people settings, including education – GOV.UK
Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial – PubMed
Efficacy of Diosmectite (Smecta)® in the Treatment of Acute Watery Diarrhoea in Adults: A Multicentre, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study – PMC
Management of Lithuanian children’s acute diarrhoea with Gastrolit solution and dioctahedral smectite – PubMed
Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate
Most times the infection settles without medication regardless if it is a bug or food poisoning. Antibiotics are not needed.
Vomiting lasts for 1-3 days average and diarrhoea lasts for 3-7 days average.
You will feel rough and unwell for the first few days with stomach cramps coming and going, no appetite and you might have temperature. Take rest.
Call the practice if:
1. if there is blood mixed with your stools. This could be a sign of a more violent bug and you might need medical treatment, especially if you are returning from tropical areas.
If you vomit violently you might see streaks or specs of blood in the vomit or the mucus you bring up, this is normally harmless. If there is more than that of blood, seek medical attention.
2. if you don’t pass urine at least twice in 24 hours (or less than 2 wet nappies in 24 hours), as you could be dehydrated.
3. if your stomach pain is severe and continuous for longer than 4 hours without breaks.
4. if you have temperature above 38.5 for longer than 3 days (it is always a good idea to have a working thermometer at home).
5. if the diarrhoea lasts for longer than 2 weeks and not improving as your doctor might want to arrange a stool sample.
6. if you are in ill health with kidney, heart or endocrine disease, or you are on certain medication that might need to be stopped or increased during an acute illness.
7. if you have severe diarrhoea with or after an antibiotic course (risk of C.difficile infection).
Advice
Do sip water between vomiting episodes even if you feel it all comes back, some will get absorbed. Once you can tolerate water well, drink pressed 100% apple juice diluted half-and-half with water to replace the minerals you have lost. You can choose to drink oral rehydration fluids, like Dioralyte, but the taste might put you off, apple juice is just as good.
Avoid squash that contains artificial sweeteners.
Continue breastfeeding your baby on demand or offer formula milk as normal.
If your child (over the age of 6 months) refuses to drink and you are concerned about them getting dehydrated, you can administer water or other fluids via a syringe (like the ones that come with medication) directly to the child’s mouth. Try 5-10ml every 10 minutes and record it on a chart. This is what nurses do in the hospital to avoid the need for an IV drip.
Only eat when you are hungry, do not force yourself. Your appetite is gone as your guts are inflamed and not ready to digest food. Give them a break to recover. Not eating for a few days is not harmful for your or your child’s body, just carry on drinking.
When you are hungry again only eat small amounts of very bland food, like white toast with jam, no butter; cooked rice, cooked potato, apple, bananas, clear vegetable or chicken soup. Avoid meat, dairy, fibres and fat until your stools are normal again. Otherwise you risk another diarrhoea episode.
Do take paracetamol and Buscopan if you need relief from pain and cramps. These medications do not cure you or shorten the disease but provide symptom relief. Absorbents, like Smecta, might shorten the diarrhoea duration (by half to one day), available without prescription.
The use of Imodium (loperamide) is controversial, several studies showed safety and efficacy, however we GPs still advise against it.
Do wash your hands regularly especially after toileting and before meals.
Children can return to school 48 hours after the last diarrhoea or vomiting episode.
Further advice:
https://www.nhs.uk/conditions/diarrhoea-and-vomiting/
Health protection in children and young people settings, including education – GOV.UK
Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial – PubMed
Efficacy of Diosmectite (Smecta)® in the Treatment of Acute Watery Diarrhoea in Adults: A Multicentre, Randomized, Double-Blind, Placebo-Controlled, Parallel Group Study – PMC
Management of Lithuanian children’s acute diarrhoea with Gastrolit solution and dioctahedral smectite – PubMed
Approach to the adult with acute diarrhea in resource-abundant settings – UpToDate
Sinusitis
Sinusitis is a viral infection in 98% of the cases that resolves on its own in about 3 weeks.
Antibiotics are not required in most cases.
Nasal saline, decongestant or steroid spray may help with symptoms (all available without prescription, please ask your Pharmacist).
Treating hay fever and stopping smoking can help
Complications are rare in patients with normal immune system.
Written information about sinusitis: https://www.nhs.uk/conditions/sinusitis-sinus-infection/
Sinusitis Information Video
Complications
Admit to hospital or offer immediate abx if hospital admission is not required:
– A severe systemic infection.
– Intraorbital or periorbital complications, including periorbital oedema or cellulitis, a displaced eyeball, double vision, ophthalmoplegia, or newly reduced visual acuity.
– Intracranial complications, including swelling over the frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs.
Antibiotics are not required in most cases.
Nasal saline, decongestant or steroid spray may help with symptoms (all available without prescription, please ask your Pharmacist).
Treating hay fever and stopping smoking can help
Complications are rare in patients with normal immune system.
Written information about sinusitis: https://www.nhs.uk/conditions/sinusitis-sinus-infection/
Sinusitis Information Video
Complications
Admit to hospital or offer immediate abx if hospital admission is not required:
– A severe systemic infection.
– Intraorbital or periorbital complications, including periorbital oedema or cellulitis, a displaced eyeball, double vision, ophthalmoplegia, or newly reduced visual acuity.
– Intracranial complications, including swelling over the frontal bone, symptoms or signs of meningitis, severe frontal headache, or focal neurological signs.
Tonsillitis – sore throat
For this type of throat infection doctors won’t suggest antibiotics as they won’t work.
Instead you can gargle with salt and water, use throat lozenges like Strepsils or antiseptic spray like Difflam that are available without prescription.
Paracetmol and Ibuprofen could be taken for pain relief.
Children can return to nursery or school when the temperature is resolved (not when it is down with Calpol) or once they are on antibiotics for 24 hours.
Sore throat due to a viral or bacterial cause is a self-limiting condition which generally resolves within two weeks.
However there are some cases where you definitely need to see a doctor with a throat infection regardless if it looks bacterial or viral:
– Immunosuppressed because of an underlying condition or treatment (like cancer treatment or Methotrexate, especially if you have a fever with the sore throat)
– If you are dehydrated (minimum 2 urination per day, or 2 wet nappies a day for young children; less than 50% of fluid intake over 24 hours)
– If you (or your child) was not immunised as a baby, so prone to serious throat infections like diphtheria, measles or epiglottitis
– If the sore throat is not improving after a week and the temperature continues over 38 ℃ for longer than 5 days
– If you develop breathing difficulty (not when you are coughing)
– If you are unable to swallow your saliva, as this could be a sign of abscess in the throat, called quinsy. The nice double arch is gone and you see a big bulge on one side, usually with the uvula shifted from the middle to one side.
General tips:
It is a good idea to have a look at your own or your child’s throat when there is no illness so you know how it looks when it is normal. This way you can appreciate the difference when a sore throat comes.
It is a good idea to have a working ear thermometer at home as feeling hot is not a reliable sign of a temperature
Please check this video to see how to take a good photo of your throat if you decide that you need to ask for advice from your doctor.
Recurrent bacterial tonsillitis might be treated with tonsillectomy, a surgery to remove the tonsils. The criteria for that is 7 or more tonsillitis episodes in a year, or 5 in each year in 2 consecutive years or 3 in each year for 3 consecutive years.
Tonsilitis Information Video
Instead you can gargle with salt and water, use throat lozenges like Strepsils or antiseptic spray like Difflam that are available without prescription.
Paracetmol and Ibuprofen could be taken for pain relief.
Children can return to nursery or school when the temperature is resolved (not when it is down with Calpol) or once they are on antibiotics for 24 hours.
Sore throat due to a viral or bacterial cause is a self-limiting condition which generally resolves within two weeks.
However there are some cases where you definitely need to see a doctor with a throat infection regardless if it looks bacterial or viral:
– Immunosuppressed because of an underlying condition or treatment (like cancer treatment or Methotrexate, especially if you have a fever with the sore throat)
– If you are dehydrated (minimum 2 urination per day, or 2 wet nappies a day for young children; less than 50% of fluid intake over 24 hours)
– If you (or your child) was not immunised as a baby, so prone to serious throat infections like diphtheria, measles or epiglottitis
– If the sore throat is not improving after a week and the temperature continues over 38 ℃ for longer than 5 days
– If you develop breathing difficulty (not when you are coughing)
– If you are unable to swallow your saliva, as this could be a sign of abscess in the throat, called quinsy. The nice double arch is gone and you see a big bulge on one side, usually with the uvula shifted from the middle to one side.
General tips:
It is a good idea to have a look at your own or your child’s throat when there is no illness so you know how it looks when it is normal. This way you can appreciate the difference when a sore throat comes.
It is a good idea to have a working ear thermometer at home as feeling hot is not a reliable sign of a temperature
Please check this video to see how to take a good photo of your throat if you decide that you need to ask for advice from your doctor.
Recurrent bacterial tonsillitis might be treated with tonsillectomy, a surgery to remove the tonsils. The criteria for that is 7 or more tonsillitis episodes in a year, or 5 in each year in 2 consecutive years or 3 in each year for 3 consecutive years.
Tonsilitis Information Video
Temperature Symptoms
Temperature Symptoms Information Video
How high was the temperature?
Sometimes people don’t check the temperature, but think they have a fever as they feel hot. Actually, when the temperature is rising we tend to feel cold and shivery. This is a more reliable sign of a temperature than feeling hot. But having a working thermometer at home is a good idea. Ear thermometers are the most reliable ones. The temperature is considered high if it is above 38.5, below that, a serious acute illness is less likely.
How long?
Temperature related to innocent infections, like respiratory viruses or tummy bugs, resolve within 5 days. Temperature is the first symptom to resolve during the recovery period. So any temperature lasting for longer than 5 days needs medical attention.
How is the patient in general?
If the patient is generally well, tolerating fluids, passing urine, can continue with some of their daily activities, or the child perks up from time to time we are less worried. If they are constantly unwell, or deteriorating, it is a red flag, and needs urgent medical attention.
What is the source of the infection?
If the patient has signs of cough, sore throat, runny and blocked nose, flu like symptoms, it is likely to be a respiratory tract infection, so we ask all the safety questions, like chest pain, breathlessness. If nothing worrying, we all can be reassured that it is a virus and will go on its own.
If the patient has stomach or urine issues we go down that route and check if medical intervention is needed.
But when we don’t find any apparent sources of infection, we really want to see the patient for physical examination and further testing to find the source.
In children who have temperature and feeling tired, unwell but nothing specific, the most common finding on examination will be tonsillitis. If the throat is clear we check the ears, the chest, the stomach, the skin for any rashes and do a urine dip test. We worry about a hidden infection that can be serious like a kidney infection or meningitis.
Is the patient in the high risk groups?
– Babies under the age of 3 months
always need to be seen urgently with a history of recorded high temperature due to the possibility of the rare but serious blood infection, called neonatal sepsis.
– Unvaccinated children and adults
might acquire serious infections that need intervention.
– The elderly
It is always a concern if an elderly person has high temperature, it always warrants medical assessment straight away and it is not safe to wait for the temperature to resolve on its own.
– With underlying conditions.
Those who have severe underlying conditions like lung, kidney, liver or heart disease or their immune system is suppressed by their illness or by medication needs to speak to seek medical attention if they develop temperature.
How high was the temperature?
Sometimes people don’t check the temperature, but think they have a fever as they feel hot. Actually, when the temperature is rising we tend to feel cold and shivery. This is a more reliable sign of a temperature than feeling hot. But having a working thermometer at home is a good idea. Ear thermometers are the most reliable ones. The temperature is considered high if it is above 38.5, below that, a serious acute illness is less likely.
How long?
Temperature related to innocent infections, like respiratory viruses or tummy bugs, resolve within 5 days. Temperature is the first symptom to resolve during the recovery period. So any temperature lasting for longer than 5 days needs medical attention.
How is the patient in general?
If the patient is generally well, tolerating fluids, passing urine, can continue with some of their daily activities, or the child perks up from time to time we are less worried. If they are constantly unwell, or deteriorating, it is a red flag, and needs urgent medical attention.
What is the source of the infection?
If the patient has signs of cough, sore throat, runny and blocked nose, flu like symptoms, it is likely to be a respiratory tract infection, so we ask all the safety questions, like chest pain, breathlessness. If nothing worrying, we all can be reassured that it is a virus and will go on its own.
If the patient has stomach or urine issues we go down that route and check if medical intervention is needed.
But when we don’t find any apparent sources of infection, we really want to see the patient for physical examination and further testing to find the source.
In children who have temperature and feeling tired, unwell but nothing specific, the most common finding on examination will be tonsillitis. If the throat is clear we check the ears, the chest, the stomach, the skin for any rashes and do a urine dip test. We worry about a hidden infection that can be serious like a kidney infection or meningitis.
Is the patient in the high risk groups?
– Babies under the age of 3 months
always need to be seen urgently with a history of recorded high temperature due to the possibility of the rare but serious blood infection, called neonatal sepsis.
– Unvaccinated children and adults
might acquire serious infections that need intervention.
– The elderly
It is always a concern if an elderly person has high temperature, it always warrants medical assessment straight away and it is not safe to wait for the temperature to resolve on its own.
– With underlying conditions.
Those who have severe underlying conditions like lung, kidney, liver or heart disease or their immune system is suppressed by their illness or by medication needs to speak to seek medical attention if they develop temperature.
