It's winter, and I've been seeing a lot of adults with tonsillitis. People miserable with fevers, sore throats and swollen, grey, painful-looking tonsils. A minority will be high-risk for strep throat and will need antibiotics. But the vast majority will have viral tonsillitis, meaning antibiotics will be useless. Or worse than useless, because they may cause diarrhoea, abdominal pain, rashes or allergic reactions, while providing no benefit.
Besides recommending fluids and paracetamol and rest, doctors haven't had many effective ways of treating really bad sore throats. We might have recommended warm saltwater gargles, over-the-counter throat sprays or lozenges, but none of these worked very well, or for very long.
But, more recently, good, reliable studies have shown us that there is something doctors can prescribe to reduce the pain and swelling of severe tonsillitis very effectively - a single dose of an oral steroid, such as prednisone.
Doctors have long used short-course steroids to treat asthma, but using them for tonsillitis is a more novel idea. So far, the studies look good: most sufferers' pain can be reduced, or completely eliminated within a day or two, with just a single dose of steroids. That's far better than anything else we've got, and it works whether the tonsillitis is bacterial or viral, and whether the patient is on antibiotics or not.
That's great news, but it's not yet widely known by doctors or their patients.
Now the caveats: the studies don't apply so well to kids (who either weren't included in the studies, or didn't show outcomes as good as adults'), or to people with severe diabetes or immune diseases, for whom steroids may actually make things worse. But, for the majority of adults with really bad tonsillitis or sore throats, there's finally something that actually works.