From the Guidelines
Recurrent pharyngitis is most commonly caused by viral infections, but can also be caused by bacterial infections, such as group A streptococcal (GAS) pharyngitis, as well as other bacteria like Arcanobacterium haemolyticum, Neisseria gonorrhoeae, and Fusobacterium necrophorum. The causes of recurrent pharyngitis can be multifactorial, including:
- Bacterial infections, such as GAS, group C streptococcus (GCS), and group G streptococcus (GGS) 1
- Viral infections, which are more common than bacterial infections
- Other factors, such as smoking, allergies, acid reflux, or immune deficiencies
The management of recurrent pharyngitis should focus on identifying and treating the underlying cause, as well as addressing contributing factors. For bacterial pharyngitis, a 10-day course of penicillin V (250-500 mg twice daily for adults) remains the first-line treatment, with alternatives for penicillin-allergic patients including azithromycin or clindamycin 1. For viral pharyngitis, treatment focuses on symptom relief with acetaminophen or ibuprofen, warm salt water gargles, and adequate hydration. Tonsillectomy may be considered for patients with severe recurrent bacterial pharyngitis, typically defined as 7+ episodes in one year, 5+ episodes per year for two years, or 3+ episodes per year for three years 1. Prevention strategies, such as good hand hygiene and avoiding close contact with sick individuals, can also help reduce the frequency and severity of recurrent pharyngitis episodes.
Key considerations in the management of recurrent pharyngitis include:
- Identifying and treating the underlying cause of the pharyngitis
- Addressing contributing factors, such as smoking, allergies, acid reflux, or immune deficiencies
- Using targeted interventions, such as antibiotics for bacterial pharyngitis or symptom relief for viral pharyngitis
- Considering tonsillectomy for patients with severe recurrent bacterial pharyngitis
- Implementing prevention strategies to reduce the frequency and severity of recurrent pharyngitis episodes.
From the Research
Causes of Recurrent Pharyngitis
The causes of recurrent pharyngitis can be attributed to various factors, including:
- Bacterial infections, with Group A beta-hemolytic streptococcus (GABHS) being the most common bacterial cause of acute pharyngitis 2, 3, 4, 5, 6
- Viral infections, as acute pharyngitis in adults is primarily a viral infection, with only about 10% of cases being of bacterial etiology 4
- Other factors, such as environmental and host-related factors, although not explicitly mentioned in the provided studies
Bacterial Causes
GABHS is the most common bacterial cause of acute pharyngitis, and its diagnosis can be confirmed by a throat culture or a rapid antigen detection test 2, 3, 5. The use of rapid antigen detection tests can provide quick results and help reduce the risk of disease spread, shorten the duration of symptoms, and decrease the incidence of suppurative complications 2.
Diagnosis and Treatment
The diagnosis of GABHS pharyngitis is crucial in determining the appropriate treatment, which typically involves a 10-day course of penicillin or amoxicillin 6. Patients allergic to penicillin can be treated with alternative antibiotics, such as first-generation cephalosporins, clindamycin, or macrolide antibiotics 6. Nonsteroidal anti-inflammatory drugs and medicated throat lozenges can also be effective in managing symptoms 6.