What is the treatment for post nasal drip pharyngitis?

Treatment of Post Nasal Drip Pharyngitis

Intranasal corticosteroids are the first-line treatment for post nasal drip pharyngitis, targeting the underlying inflammation causing the symptoms. 1

Diagnosis Considerations

Before initiating treatment, it's important to identify the underlying cause of post nasal drip pharyngitis:

• Common causes include:

  • Allergic rhinitis
  • Chronic sinusitis
  • Non-allergic rhinitis
  • Upper airway cough syndrome (UACS)
  • Viral upper respiratory infections

• Key symptoms to evaluate:

  • Nasal congestion
  • Rhinorrhea (anterior and posterior)
  • Throat irritation
  • Cough (especially at night)
  • Sensation of mucus in the throat

Treatment Algorithm

First-Line Treatment:

1. Intranasal corticosteroids 2, 1
   • Examples: fluticasone propionate nasal spray
   • Dosage: 1-2 sprays in each nostril once or twice daily
   • Duration: Initial 1-month trial, may continue for up to 3 months if effective
   • Mechanism: Reduces inflammation in nasal passages, decreasing mucus production

Second-Line/Adjunctive Treatments:

1. First-generation antihistamine-decongestant combinations 2, 1

   • Examples: dexbrompheniramine maleate plus sustained-release pseudoephedrine
   • Duration: At least 3 weeks
   • Particularly useful when allergic components are present
   • Caution: May cause sedation, dry mouth, urinary retention; use with caution in patients with glaucoma, prostatic hypertrophy, or hypertension

2. Saline nasal irrigation 2

   • Helps clear mucus and irritants from nasal passages
   • Can be used as adjunct to other therapies
   • Low risk of adverse effects

3. Nasal ipratropium bromide 1

   • Particularly effective for rhinorrhea-predominant symptoms
   • Can be used in combination with intranasal corticosteroids

4. Leukotriene receptor antagonists 1

   • May be considered as an additional treatment option
   • Particularly useful when allergic components are present

For Specific Underlying Causes:

When Chronic Sinusitis is Present:

• Consider antibiotics if bacterial infection is suspected 2
  • First-line: Amoxicillin (500 mg twice daily for adults)
  • For non-responders: High-dose amoxicillin-clavulanate, cephalosporins, macrolides, or quinolones
  • Duration: 10-14 days

For Allergic Components:

• Second-generation oral antihistamines may be added 3
• Consider azelastine nasal spray for rapid symptom relief 4

Special Considerations

For Refractory Cases:

• Reassess diagnosis and consider other causes of symptoms
• Consider macrolide therapy for intractable cases 5
• Evaluate for structural abnormalities that may require surgical intervention
• Consider referral to an otolaryngologist or allergist

Supportive Measures:

• Adequate hydration
• Warm facial packs
• Sleeping with head elevated
• Avoiding irritants (cigarette smoke, pollution, allergens)

Monitoring:

• Evaluate response after 3-5 days of treatment
• If minimal improvement after 10-14 days, consider changing therapy
• For partial response, continue treatment for another 10-14 days

Cautions and Contraindications

• Intranasal corticosteroids may cause local irritation, epistaxis, or rarely, nasal septal perforation 6
• First-generation antihistamines may cause significant sedation and anticholinergic effects 1
• Decongestants should be used with caution in patients with hypertension, cardiovascular disease, glaucoma, or prostatic hypertrophy 2
• Avoid prolonged use of topical decongestants (>3-5 days) to prevent rhinitis medicamentosa 7

Post nasal drip pharyngitis typically responds well to appropriate treatment targeting the underlying cause, with intranasal corticosteroids being the cornerstone of therapy for most patients.