From the Guidelines
For an 11-year-old boy with a sore throat and negative strep, COVID, and influenza tests, I recommend symptomatic treatment with ibuprofen or paracetamol for relief of acute sore throat symptoms. The European Society for Clinical Microbiology and Infectious Diseases guideline 1 suggests that either ibuprofen or paracetamol can be used to treat sore throat. Given the negative test results, this likely represents a viral pharyngitis that will resolve on its own within 5-7 days.
Key Considerations
- The Centor clinical scoring system or rapid antigen test can be helpful in targeting antibiotic use, but in this case, the negative strep test suggests that antibiotics are not indicated 1.
- Zinc gluconate is not recommended for use in sore throat, and there is inconsistent evidence for herbal treatments and acupuncture as treatments for sore throat 1.
- The goal of treatment is to provide comfort while the immune system clears the infection, and antibiotics should not be used in patients with less severe presentation of sore throat.
Treatment Approach
- Symptomatic treatment with ibuprofen or paracetamol as needed for pain and fever
- Warm salt water gargles (1/4 teaspoon salt in 8 oz warm water) several times daily
- Adequate hydration with cool liquids
- Monitoring for worsening symptoms or signs of complications, such as difficulty breathing, drooling, severe difficulty swallowing, or dehydration, which would require immediate medical attention.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Appropriate Workup for Sore Throat
- The patient has already undergone a negative Streptococcal (Strep) throat screen, negative Coronavirus disease 2019 (COVID-19), and negative Influenza tests 2, 3, 4, 5.
- Given the negative test results, the focus should be on managing symptoms and monitoring for potential complications.
Treatment Approach
- According to the study by 2, antibiotic therapy is not justified for patients with mild symptoms or without signs of progression to locoregional suppuration, unless the local incidence of acute rheumatic fever is high.
- The study by 3 suggests that a child with sore throat and toxic look may have diphtheria or parapharyngeal/retropharyngeal abscess, and therefore should be hospitalized.
- The study by 4 found that rapid streptococcal testing was associated with a lower antibiotic prescription rate for children with pharyngitis, and supports the screening of all children with pharyngitis by performing an RST to guide decision making for antibiotic administration.
- The study by 5 suggests that a throat culture remains important when a screening test of a patient with suspected streptococcal pharyngitis is negative.
Management Strategies
- The study by 6 conducted a multi-criteria decision analysis using the Analytic Hierarchy Process to determine the optimal management of adults with pharyngitis, and found that the optimal clinical management depends on both the clinical probability of a group A streptococcal infection and clinical judgments that incorporate individual patient and practice circumstances.
- For the 11-year-old boy with a sore throat and negative test results, a management strategy that includes monitoring for potential complications, managing symptoms, and considering further testing or antibiotic therapy if symptoms worsen or do not improve, may be appropriate 2, 3, 4, 5.