Management of Viral Pharyngitis
For viral pharyngitis, symptomatic treatment is recommended as the mainstay of therapy, focusing on pain relief and fever reduction with acetaminophen or NSAIDs, while avoiding unnecessary antibiotics. 1
Diagnosis of Viral Pharyngitis
- Testing for Group A Streptococcus (GAS) is not recommended for children or adults with clinical features strongly suggesting viral etiology (cough, rhinorrhea, hoarseness, and oral ulcers) 1
- Viral pharyngitis accounts for 70-85% of pharyngitis cases in children and 85-95% in adults 2
- Clinical features suggesting viral etiology include:
- Cough
- Rhinorrhea (runny nose)
- Hoarseness
- Oral ulcers 1
Symptomatic Treatment Recommendations
First-line options:
- Acetaminophen or NSAIDs for moderate to severe symptoms or fever control 1
- NSAIDs may be more effective than acetaminophen for fever and pain relief 2
- Aspirin should be avoided in children due to the risk of Reye syndrome 1
Additional symptomatic treatments:
- Medicated throat lozenges used every two hours can provide effective symptom relief 2
- Topical agents containing anesthetics (ambroxol, lidocaine, benzocaine) may provide temporary symptomatic relief 1
- Warm salt water gargles for patients old enough to gargle, though this has not been studied in detail 1
- Ensure adequate hydration and rest 3
Special Considerations
- Corticosteroids are not recommended for routine use in viral pharyngitis as they provide only minimal reduction in symptom duration (approximately 5 hours) and have potential adverse effects 1, 2
- Ectoine lozenges have shown promise in relieving moderate-to-severe symptoms of acute viral pharyngitis in some studies, demonstrating better effectiveness and tolerability than hyaluronic acid lozenges and hypertonic saline gargles 4
Common Pitfalls to Avoid
- Prescribing antibiotics for viral pharyngitis, which provides no benefit and contributes to antibiotic resistance 1, 5
- Failing to distinguish between viral and bacterial pharyngitis based on clinical features 2, 6
- Using aspirin in children with viral infections due to risk of Reye syndrome 1, 5
- Overuse of corticosteroids for symptom relief 1, 2
When to Consider Alternative Diagnoses
- Persistent symptoms beyond 7-10 days 3
- High fever (>101°F or 38.3°C) with absence of cough and presence of tonsillar exudates and tender cervical lymphadenopathy (suggesting possible streptococcal infection) 2, 6
- Severe difficulty swallowing or breathing (may indicate epiglottitis or peritonsillar abscess) 3
By following these evidence-based recommendations for the management of viral pharyngitis, clinicians can provide effective symptomatic relief while avoiding unnecessary antibiotic use and potential complications.