From the Guidelines
A sore throat workup should begin with a thorough history and physical examination to determine the likely cause, and antibiotics should only be considered in patients with confirmed streptococcal pharyngitis or those with severe symptoms. For viral pharyngitis, which accounts for about 80% of cases, symptomatic treatment with acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours), warm salt water gargles, and adequate hydration is recommended 1. If streptococcal pharyngitis is suspected based on symptoms like fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough, a rapid strep test or throat culture should be performed. If positive for Group A Streptococcus, treatment with penicillin V (500mg twice daily for 10 days) is recommended 1.
Some key points to consider in the workup and treatment of sore throat include:
- The use of the Centor clinical scoring system or rapid antigen test to help identify patients with a higher likelihood of group A streptococcal infection 1
- The consideration of antibiotic therapy only in patients with confirmed streptococcal pharyngitis or those with severe symptoms 1
- The recommendation against the use of zinc gluconate in sore throat 1
- The inconsistent evidence for the use of herbal treatments and acupuncture in sore throat 1
In terms of specific treatment options, penicillin V (500mg twice daily for 10 days) is recommended as the first-line antibiotic for patients with acute sore throat 1. It is also important to note that antibiotics should not be used to relieve symptoms in patients with less severe presentations of sore throat (e.g. 0-2 Centor criteria) 1.
Overall, the goal of the sore throat workup is to determine the likely cause of the symptoms and to provide appropriate treatment, while also avoiding unnecessary antibiotic use and minimizing the risk of complications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Sore Throat Workup
- A sore throat is a common reason for consultation of family physicians, usually triggered by infections of the pharynx 2
- Less than 35% of cases are caused by bacterial infections, but antibiotics are prescribed far more often 2
- Evidence-based guideline recommendations are available to reduce non-indicated administration of antibiotics in the treatment of sore throat 2
Clinical Scores
- Clinical scores such as Centor, McIsaac, and FeverPAIN should be used to assess the risk of bacterial pharyngitis 2, 3
- If the score is low (< 3 points), antibiotics are not indicated; if moderate (3 points), delayed prescription is an option; if high (> 3 points), antibiotics can be taken immediately 2
- The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy 4
Diagnostic Tests
- Throat culture is considered the diagnostic standard, although the sensitivity and specificity of rapid antigen detection testing have improved significantly 4
- Rapid antigen detection testing can be used to diagnose group A beta-hemolytic streptococcal pharyngitis, especially in patients with a high clinical suspicion 5
- A throat culture is recommended in children and adolescents after a negative rapid antigen test result 5
Treatment
- Penicillin and amoxicillin are first-line antibiotics for the treatment of streptococcal pharyngitis, with a recommended course of 10 days 4, 5
- First-generation cephalosporins are recommended for patients with nonanaphylactic allergies to penicillin 4, 5
- Steroids are not recommended for symptomatic treatment of sore throat 5
Management
- Patients should be encouraged in self-management, and ibuprofen and naproxen are recommended for symptomatic treatment 2
- A regular use of symptomatic treatment will help to control discomfort in the absence of red flags 2
- Tonsillectomy is rarely recommended as a preventive measure, and the benefits are too small to outweigh the associated costs and surgical risks 4, 5