What is the treatment for viral pharyngitis?

Treatment for Viral Pharyngitis

The primary treatment for viral pharyngitis is symptomatic relief with analgesics such as ibuprofen or paracetamol (acetaminophen), along with adequate hydration. 1 Antibiotics are not recommended for viral pharyngitis as they provide no benefit and may contribute to antibiotic resistance.

Diagnosis and Differentiation

Before initiating treatment, it's important to differentiate viral from bacterial pharyngitis:

• Viral pharyngitis indicators: Presence of cough, rhinorrhea, hoarseness, and oral ulcers 2
• Bacterial pharyngitis indicators: Use Centor Criteria (fever, tonsillar exudates, absence of cough, and tender anterior cervical lymphadenopathy) 1

Testing for Group A Streptococcus (GAS) is not recommended when clinical features strongly suggest viral etiology 2.

Treatment Approach

First-line Management

1. Analgesics/antipyretics:

   • Adults: Ibuprofen 400mg every 6-8 hours (maximum 1200mg/day) or paracetamol 500-1000mg every 4-6 hours (maximum 4000mg/day) 1
   • Children: Ibuprofen 5-10mg/kg every 6-8 hours or paracetamol 10-15mg/kg every 4-6 hours 1
   • Note: Aspirin should be avoided in children due to risk of Reye syndrome 2, 1

2. Hydration:

   • Encourage adequate fluid intake to maintain hydration 1
   • Warm saltwater gargles may provide temporary relief

3. Rest:

   • Adequate rest helps the immune system fight the viral infection

Additional Supportive Measures

• Throat lozenges containing local anesthetics may provide temporary relief
• Humidification of room air may help with symptoms
• Ectoine lozenges have shown efficacy in relieving moderate-to-severe symptoms of acute viral pharyngitis 3

When Not to Use Antibiotics

Antibiotics should not be prescribed for viral pharyngitis because:

• They are ineffective against viruses
• They contribute to antibiotic resistance
• They may cause unnecessary side effects
• They provide only modest benefit even in bacterial pharyngitis 4

Special Considerations

For Children

• Children under 3 years: Focus on age-appropriate symptomatic relief 1
• Ensure proper dosing of antipyretics based on weight

Prevention Measures

• Hand hygiene
• Avoiding close contact with infected individuals
• Not sharing utensils or drinks 1

When to Seek Further Medical Attention

Advise patients to seek further medical attention if:

• Symptoms worsen after 3-5 days
• Difficulty breathing or swallowing develops
• Severe pain or inability to take fluids occurs
• High fever persists despite antipyretics

Common Pitfalls to Avoid

1. Unnecessary antibiotic use: Antibiotics do not shorten the duration of viral pharyngitis and may lead to resistance and side effects
2. Inadequate pain management: Ensure proper dosing of analgesics for effective symptom relief
3. Insufficient hydration: Dehydration can worsen symptoms and delay recovery
4. Misdiagnosis: Be vigilant for signs suggesting bacterial rather than viral etiology, especially in high-risk populations

Remember that viral pharyngitis is self-limiting, and treatment should focus on symptom relief while the infection runs its course.