What are the treatment guidelines for acute pharyngitis?

From the Guidelines

Treatment of acute pharyngitis should begin with determining its likely cause through clinical evaluation and, when appropriate, rapid strep testing or throat culture, and for confirmed Group A Streptococcal (GAS) pharyngitis, antibiotic therapy is recommended to prevent complications and reduce symptom duration, with first-line treatment being penicillin V or amoxicillin for 10 days, as recommended by the Infectious Diseases Society of America 1. For viral pharyngitis, which accounts for most cases, treatment is supportive with rest, adequate hydration, saltwater gargles, and over-the-counter pain relievers like acetaminophen or ibuprofen. Some key points to consider in the treatment of acute pharyngitis include:

• Determining the likely cause of pharyngitis through clinical evaluation and diagnostic testing
• Using antibiotic therapy for confirmed GAS pharyngitis to prevent complications and reduce symptom duration
• Selecting appropriate antibiotic regimens, such as penicillin V or amoxicillin, for 10 days, as recommended by the Infectious Diseases Society of America 1
• Considering alternative antibiotic regimens for penicillin-allergic patients, such as cephalexin, clindamycin, azithromycin, or clarithromycin, as recommended by the Infectious Diseases Society of America 1
• Completing the full antibiotic course, even if symptoms improve quickly, to prevent recurrence and complications like rheumatic fever
• Providing supportive care, such as rest, hydration, and symptomatic relief, to patients with pharyngitis
• Returning to school or work 24 hours after starting antibiotics if fever-free
• Avoiding antibiotics for viral pharyngitis, as they provide no benefit and contribute to antibiotic resistance, as noted by the American Heart Association 1 and the Infectious Diseases Society of America 1.

It is essential to follow the guidelines and recommendations from reputable sources, such as the Infectious Diseases Society of America and the American Heart Association, to ensure appropriate diagnosis and treatment of acute pharyngitis, and to minimize the risk of complications and antibiotic resistance 1.

From the FDA Drug Label

In three double-blind controlled studies, conducted in the United States, azithromycin (12 mg/kg once a day for 5 days) was compared to penicillin V (250 mg three times a day for 10 days) in the treatment of pharyngitis due to documented Group A β-hemolytic streptococci (GABHS or S. pyogenes) Azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 with the following clinical success (i.e., cure and improvement) and bacteriologic efficacy rates (for the combined evaluable patient with documented GABHS): Three U. S. Streptococcal Pharyngitis Studies Azithromycin vs. Penicillin V EFFICACY RESULTS Day 14 Day 30 Bacteriologic Eradication: Azithromycin 323/340 (95%) 255/330 (77%) Penicillin V 242/332 (73%) 206/325 (63%) Clinical Success (Cure plus improvement): Azithromycin 336/343 (98%) 310/330 (94%) Penicillin V 284/338 (84%) 241/325 (74%)

The recommended treatment guidelines for acute pharyngitis caused by Group A β-hemolytic streptococci (GABHS) include:

• Azithromycin: 12 mg/kg once a day for 5 days
• Penicillin V: 250 mg three times a day for 10 days It is essential to note that azithromycin was clinically and microbiologically statistically superior to penicillin at Day 14 and Day 30 in the treatment of pharyngitis due to documented GABHS 2. Additionally, amoxicillin may also be used to treat pharyngitis, with a recommended dosage of 500 mg every 12 hours or 250 mg every 8 hours for adults and pediatric patients aged 3 months and older and weight less than 40 kg 3.

From the Research

Diagnosis of Acute Pharyngitis

• The diagnosis of acute pharyngitis is based on a combination of clinical findings, patient history, and diagnostic tests 4, 5, 6, 7, 8
• Clinical scoring systems, such as the Centor or FeverPAIN score, can be used to identify patients who are likely to have Group A beta-hemolytic streptococcal (GABHS) pharyngitis 5, 6
• Rapid antigen detection tests and throat cultures can be used to confirm the diagnosis of GABHS pharyngitis 4, 5, 6, 7, 8

Treatment of Acute Pharyngitis

• The treatment of acute pharyngitis depends on the cause of the infection 4, 5, 6, 7, 8
• For GABHS pharyngitis, the recommended first-line therapy is a 10-day course of penicillin V or amoxicillin 4, 5, 6
• Alternative antibiotics, such as cephalosporins and macrolides, can be used in patients who are allergic to penicillin or have other contraindications 4, 5
• Nonsteroidal anti-inflammatory drugs and medicated throat lozenges can be used to relieve symptoms such as fever and pain 5
• Corticosteroids are not recommended for routine use in the treatment of acute pharyngitis 5

Antibiotic Use and Resistance

• Antibiotics should only be prescribed for patients who are likely to have GABHS pharyngitis, as identified by clinical scoring systems and diagnostic tests 6, 7, 8
• The use of narrow-spectrum antibiotics, such as penicillin, is recommended to minimize the risk of antibiotic resistance 7
• The development of antibiotic resistance is a concern, and efforts should be made to minimize unnecessary antibiotic use 4, 7