What is the recommended treatment for viral pharyngitis?

Treatment of Viral Pharyngitis

For viral pharyngitis, symptomatic treatment with NSAIDs such as ibuprofen is the recommended first-line approach, with acetaminophen as an alternative, while antibiotics should be avoided as they provide no benefit for viral infections. 1

Diagnosis and Differentiation

Before initiating treatment, it's important to distinguish viral from bacterial pharyngitis:

• Most pharyngitis cases (approximately 90% in adults) are viral in origin 2, 3
• Use Centor criteria to assess likelihood of Group A Streptococcal (GAS) pharyngitis:
  • Fever
  • Tonsillar exudates
  • No cough
  • Tender anterior cervical lymphadenopathy 1, 3
• Patients with 0-1 criteria are unlikely to have GAS and should receive symptomatic treatment only 3
• Patients with 2+ criteria may require testing (rapid antigen detection test or throat culture) 4, 1

First-Line Symptomatic Treatment

1. Pain and Fever Management:

   • NSAIDs (e.g., ibuprofen) provide superior pain and fever relief compared to acetaminophen 1
   • Acetaminophen is an acceptable alternative, especially if NSAIDs are contraindicated
   • Note: Aspirin is contraindicated in children due to risk of Reye syndrome 1

2. Supportive Care Options:

   • Warm salt water gargles for patients old enough to gargle 1
   • Adequate hydration
   • Rest

3. Topical Treatments:

   • Lozenges or sprays containing benzocaine, lidocaine, or ambroxol for temporary relief 1
   • Caution: Lozenges are a choking hazard for young children 1
   • Ectoine lozenges have shown efficacy in reducing pharyngitis symptoms (79.5% reduction in symptom scores) 5
   • Chlorhexidine/benzydamine mouth spray has demonstrated efficacy in reducing pain and improving quality of life 6

Important Considerations

• Avoid Antibiotics: Antibiotics provide no benefit for viral pharyngitis and contribute to antibiotic resistance 1, 3
• Duration: Most viral pharyngitis cases are self-limited and resolve within 7-10 days 2
• Corticosteroids: Not recommended for routine use in viral pharyngitis as they provide minimal symptom reduction and have potential adverse effects 1

When to Seek Further Medical Attention

Advise patients to seek medical attention if:

• Symptoms persist beyond 7 days
• Difficulty swallowing or breathing develops
• High fever persists despite antipyretics 1

Common Pitfalls to Avoid

1. Overuse of antibiotics for viral pharyngitis (provides no benefit and increases antibiotic resistance) 1
2. Inadequate pain management (pain relief should be prioritized regardless of etiology) 1
3. Relying solely on clinical features to distinguish viral from bacterial pharyngitis (clinical features have limited accuracy) 1

For healthcare workers with viral pharyngitis, return to work can occur once symptoms are improving and fever has resolved, though those with confirmed GAS pharyngitis should remain isolated from patient care until they have completed at least 24 hours of appropriate antibiotic therapy 1.