What are the treatment options for pharyngitis?

From the Guidelines

For patients with pharyngitis, I recommend treating with antibiotics only if they have confirmed streptococcal pharyngitis, and otherwise managing symptoms with analgesic therapy, such as aspirin, acetaminophen, nonsteroidal anti-inflammatory drugs, and throat lozenges. The treatment of pharyngitis should prioritize the eradication of group A Streptococcus from the pharynx, usually with a 10-day course of an appropriate narrow-spectrum antibiotic 1. However, most pharyngitis cases are caused by viruses, and antibiotics are not recommended unless there is a confirmed diagnosis of group A streptococcal infection.

Symptomatic Management

For patients with a sore throat, symptomatic management is crucial to reduce pain and inflammation. This can include:

• Gargling with warm salt water several times daily
• Drinking plenty of warm fluids
• Using throat lozenges containing menthol or benzocaine for temporary pain relief
• Over-the-counter pain medications such as acetaminophen (325-650mg every 4-6 hours, not exceeding 3000mg daily) or ibuprofen (200-400mg every 4-6 hours with food) 1

Antibiotic Use

Antibiotics should only be prescribed for patients with confirmed group A streptococcal pharyngitis, as they can help prevent complications such as acute rheumatic fever, peritonsillar abscess, and further spread of group A Streptococcus in outbreaks 1. However, the benefit of antibiotics in reducing symptoms 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 1.

High-Value Care Advice

Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis using rapid antigen detection test and/or culture for group A Streptococcus, and treat patients with antibiotics only if they have confirmed streptococcal pharyngitis 1. Patients can be assured that the typical course of a sore throat is less than 1 week, and that antibiotics are usually not needed because they do little to alleviate symptoms and may have adverse effects 1.

From the FDA Drug Label

Streptococcal infections (without bacteremia): Mild to moderate infections of the upper respiratory tract, scarlet fever and mild erysipelas. Fusospirochetosis (Vincent's gingivitis and pharyngitis): Mild to moderately severe infections of the oropharynx usually respond to therapy with oral penicillin.

The treatment options for pharyngitis include oral penicillin for mild to moderately severe infections of the oropharynx, specifically for Streptococcal infections and Fusospirochetosis (Vincent's gingivitis and pharyngitis) 2.

• Amoxicillin may also be considered for the treatment of pharyngitis caused by Streptococcus pyogenes, with a recommended treatment duration of at least 10 days to prevent the occurrence of acute rheumatic fever 3.
• Key considerations for treatment include:
  • Bacteriological studies: Guiding therapy based on sensitivity tests and clinical response.
  • Local epidemiology and susceptibility patterns: Informing empiric selection of therapy in the absence of culture and susceptibility data.

From the Research

Treatment Options for Pharyngitis

The treatment options for pharyngitis can be categorized into several approaches, including:

• Symptomatic management as the first-line treatment, as most cases of sore throat are viral and/or self-limiting 4, 5
• Use of locally delivered medications, such as flurbiprofen 8.75 mg, for symptomatic relief from throat pain and soreness 4
• Use of ambroxol lozenges, which have been shown to be safe and efficacious in reducing sore throat pain intensity 6
• Antibiotic therapy, which may be considered for patients with more severe illness and signs of group A streptococcal (GAS) pharyngitis 5, 7
• Systemic analgesics, such as acetylsalicylic acid, acetaminophen, flurbiprofen, or ibuprofen, which are valid treatment options for symptomatic relief 8
• Local anesthetics, such as lidocain, benzocaine, and ambroxol, which have been shown to be effective in clinical trials and can be recommended in the first-line treatment 8

Non-Pharmacological Approaches

There is limited evidence on non-pharmacological approaches to treating pharyngitis, but some studies suggest that:

• Tonsillectomy or adenoidectomy may not be effective in reducing the incidence of GAS pharyngitis 7
• Chronic GAS colonization is common despite appropriate use of antibiotic therapy, and there is generally no need to treat carriers 7

Pharmacological Treatment

The pharmacological treatment of pharyngitis depends on the severity and cause of the infection, and may include:

• Penicillin or amoxicillin as the treatment of choice for GAS pharyngitis 7
• Erythromycin and first-generation cephalosporins as options for patients with penicillin allergy 7
• Flurbiprofen, ibuprofen, and other systemic analgesics for symptomatic relief 4, 8
• Local anesthetics, such as ambroxol, for symptomatic relief 6, 8