What are the recommended medications for viral pharyngitis cough?

Recommended Medications for Viral Pharyngitis Cough

For viral pharyngitis cough, symptomatic treatment with NSAIDs (like ibuprofen), acetaminophen, cough suppressants (like dextromethorphan), and throat lozenges is recommended as antibiotics are not effective against viral infections. 1

First-Line Symptomatic Treatments

Pain and Inflammation Relief

• Ibuprofen (400-600 mg every 6-8 hours) is recommended as first-line treatment for pain relief in viral pharyngitis, showing slightly better efficacy as both an analgesic and antipyretic compared to acetaminophen 1, 2
• Acetaminophen can be used as an alternative for those who cannot take NSAIDs

Cough Management

• Dextromethorphan (extended-release formulations providing 12-hour relief) is effective for suppressing cough associated with viral pharyngitis 3
• Available as alcohol-free liquid formulations that can be taken day or night

Topical Treatments

• Warm salt water gargles can help alleviate throat discomfort 1
• Throat lozenges used every two hours are effective for symptom relief 1, 4
• Ectoine lozenges have shown superior effectiveness compared to hyaluronic acid lozenges and hypertonic saline gargle in reducing pharyngitis symptoms (79.5% reduction in symptom scores) 5
• Chlorhexidine/benzydamine mouth spray combined with acetaminophen has demonstrated significant reduction in pain and improved quality of life compared to acetaminophen alone 6

Important Clinical Considerations

Diagnostic Approach

• Viral pharyngitis is differentiated from bacterial (streptococcal) pharyngitis using clinical criteria:
  • Presence of cough suggests viral etiology
  • Absence of tonsillar exudates suggests viral etiology
  • Absence of fever suggests viral etiology
  • Absence of tender anterior cervical lymph nodes suggests viral etiology 1

When to Avoid Antibiotics

• Antibiotics should not be used for viral pharyngitis as they:
  • Provide no benefit against viral infections
  • Can cause side effects
  • Negatively impact gut microbiota
  • Contribute to antibiotic resistance 1

Duration of Symptoms

• Patients should be reassured that viral pharyngitis symptoms typically resolve within one week with symptomatic treatment 1
• Newer treatments like chlorpheniramine maleate throat spray may reduce symptom duration to approximately three days, though more research is needed 7

Special Considerations

Emerging Treatments

• Chlorpheniramine maleate throat spray shows promise for COVID-19-induced viral pharyngitis, potentially due to its antiallergic, anti-inflammatory, and broad-spectrum antiviral properties 7

Common Pitfalls to Avoid

1. Prescribing antibiotics unnecessarily - viral pharyngitis does not respond to antibiotics
2. Failing to provide adequate pain relief - ibuprofen is more effective than acetaminophen for pharyngitis pain
3. Overlooking the value of topical treatments - lozenges and gargles can provide significant symptom relief
4. Not reassuring patients about the self-limiting nature of viral pharyngitis

Remember that viral pharyngitis is self-limiting, and treatment focuses on symptom management rather than targeting the underlying viral cause. A combination of systemic pain relievers, cough suppressants, and topical treatments typically provides the most effective symptom relief.