What are the differences in treatment for pharyngitis and laryngitis?

Treatment Differences Between Pharyngitis and Laryngitis

The primary treatment difference is that pharyngitis often requires antibiotics when caused by Group A Streptococcus, while laryngitis is typically managed with supportive care and voice rest as it is predominantly viral in origin. 1

Pharyngitis Treatment

Diagnostic Approach

• Use Centor Criteria to assess likelihood of streptococcal pharyngitis:
  • Tonsillar exudates
  • Tender anterior cervical lymph nodes
  • Lack of cough
  • Fever 2
• Patients with 0-2 criteria: unlikely to have GAS infection, no testing needed
• Patients with 3-4 criteria: test with rapid antigen detection test (RADT) and/or throat culture 2

Treatment Algorithm

1. Viral pharyngitis (most common):

   • Supportive care only
   • Analgesics/antipyretics (acetaminophen or NSAIDs)
   • No antibiotics indicated 1, 2

2. Bacterial pharyngitis (GAS confirmed):

   • First-line: Penicillin V

     • Children: 250 mg 2-3 times daily for 10 days
     • Adults: 500 mg 2-3 times daily for 10 days 1, 2

   • Alternative regimens:

     • Amoxicillin: 50 mg/kg once daily (max 1000 mg) or 25 mg/kg twice daily (max 500 mg per dose) for 10 days
     • For penicillin allergy (non-anaphylactic): First-generation cephalosporins for 10 days
     • For anaphylactic penicillin allergy: Clindamycin (300-450 mg three times daily), clarithromycin, or azithromycin 2

3. Complete full 10-day course of antibiotics to prevent acute rheumatic fever, even if symptoms improve earlier 2

Laryngitis Treatment

Diagnostic Approach

• Primarily a clinical diagnosis
• Characterized by hoarseness, voice changes, and possible sore throat
• Typically viral in origin 3

Treatment Algorithm

1. Acute viral laryngitis (most common):

   • Voice rest (primary treatment)
   • Adequate hydration
   • Humidification
   • Avoid irritants (smoking, alcohol)
   • Symptomatic treatment with analgesics/antipyretics 3
   • No antibiotics indicated unless secondary bacterial infection suspected

2. Chronic or post-viral laryngitis:

   • May require neuromodulators if postviral vagal neuropathy is suspected
   • Consider referral to otolaryngology if symptoms persist beyond 2-3 weeks 3

3. Rare forms (e.g., laryngeal shingles, idiopathic ulcerative laryngitis):

   • May require specialized treatment and referral to otolaryngology 3

Key Differences and Clinical Pearls

1. Anatomical focus:

   • Pharyngitis: Inflammation of pharynx/throat
   • Laryngitis: Inflammation of larynx/voice box

2. Predominant symptoms:

   • Pharyngitis: Sore throat, pain on swallowing
   • Laryngitis: Hoarseness, voice changes, possible mild throat discomfort

3. Antibiotic indications:

   • Pharyngitis: Antibiotics indicated for confirmed GAS infection
   • Laryngitis: Rarely requires antibiotics as it's predominantly viral 1, 3

4. Common pitfalls to avoid:

   • Don't prescribe antibiotics for viral pharyngitis or laryngitis
   • Don't discontinue antibiotics early for GAS pharyngitis even if symptoms improve
   • Don't overlook potential serious complications of untreated GAS pharyngitis (rheumatic fever, glomerulonephritis) 1, 2
   • Recent evidence suggests antibiotics may have limited impact on symptom duration in children with GAS pharyngitis, but guidelines still recommend treatment to prevent complications 4

5. Red flags requiring immediate attention:

   • Difficulty breathing or swallowing
   • Drooling
   • Significant voice changes
   • Neck swelling or limited neck movement
   • Severe systemic symptoms 2

By following these treatment algorithms and understanding the key differences between pharyngitis and laryngitis, clinicians can provide appropriate care while avoiding unnecessary antibiotic use.