From the Guidelines
Treatment of viral pharyngitis primarily involves supportive care since antibiotics are ineffective against viruses. Patients should focus on rest, adequate hydration, and over-the-counter pain relievers such as acetaminophen (325-650 mg every 4-6 hours, not exceeding 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) to manage throat pain and fever, as recommended by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Key Considerations
- Warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily can provide temporary relief.
- Throat lozenges containing benzocaine or menthol may also help soothe discomfort.
- Humidification of air and consuming cold liquids or popsicles can further ease symptoms.
- Most viral pharyngitis cases resolve within 7-10 days without specific antiviral treatment.
When to Seek Medical Attention
If symptoms persist beyond 10 days, worsen after initial improvement, or are accompanied by difficulty breathing or swallowing, patients should seek medical attention as this may indicate a bacterial infection or complications, as suggested by the Infectious Diseases Society of America 2, 3.
Additional Guidance
The IDSA clinical guidelines recommend antibiotic therapy only for patients with a positive streptococcal test result 2. For patients diagnosed with group A streptococcal infection, antibiotics shorten the duration of sore throat by 1 to 2 days, but the benefit is modest and the number needed to treat to reduce symptoms is 6 after 3 days of treatment and 21 after 1 week of treatment 4.
Conclusion is not needed, the answer is complete as per the provided instructions.
From the Research
Treatment of Viral Pharyngitis
- The use of aspirin or nonsteroidal anti-inflammatory agents (NSAIAs) is advised in adults and NSAIAs in children for the treatment of pain in viral pharyngitis 5.
- Studies have shown that NSAIAs relieve pharyngitis pain better than acetaminophen 5.
- A single dose of dexamethasone can be used as an adjuvant therapy for acute pharyngitis, reducing pharyngeal inflammatory pain 6.
- The treatment of pharyngitis caused by Streptococcus pyogenes typically requires antimicrobial therapy, with penicillin being the antibiotic of choice 5, 7.
Diagnosis and Treatment Approach
- A thorough history is key to diagnosing pharyngitis, and rapid antigen detection tests should be reserved for concerns about antibiotic initiation 8.
- The Modified Centor score can be used to guide management and predict Group A Streptococcus (GAS) infection 9.
- Management algorithms that include the use of predictive clinical rules and rapid tests can help clinicians to better predict suspected bacterial aetiology and reduce unnecessary prescriptions of antibiotics 7.
Antibiotic Prescribing and Use of Corticosteroids
- A higher Centor score is associated with a higher risk of GAS infection, increased antibiotic prescribing, and use of corticosteroids 9.
- Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis, while macrolides should be reserved for patients allergic to penicillin 7.
- The use of corticosteroids, such as dexamethasone, can provide significant relief of pain in patients with acute pharyngitis 6, 9.