From the Guidelines
For pharyngitis that has progressed to congestion and coughing, the diagnosis is likely viral in origin, and most cases are self-limited, resolving within 7-10 days without the need for antibiotics, as indicated by the American College of Physicians and the Centers for Disease Control and Prevention 1.
Key Considerations
- The presence of cough, nasal congestion, conjunctivitis, hoarseness, diarrhea, or oropharyngeal lesions (ulcers or vesicles) suggests a viral illness, and further testing for bacterial causes is not warranted unless specific criteria are met 1.
- The modified Centor criteria, which include fever by history, tonsillar exudates, tender anterior cervical adenopathy, and absence of cough, can help determine the likelihood of a bacterial cause, but they have a low positive predictive value for group A streptococcal infection 1.
Management Strategies
- Over-the-counter medications such as acetaminophen (Tylenol) 650mg every 6 hours or ibuprofen (Advil, Motrin) 400mg every 6-8 hours can help manage pain and fever.
- Decongestants like pseudoephedrine (Sudafed) 30-60mg every 4-6 hours or phenylephrine 10mg every 4 hours can alleviate congestion.
- Cough suppressants containing dextromethorphan (such as Robitussin DM) can help control coughing, typically 10-20mg every 4 hours.
- Staying hydrated with at least 8-10 glasses of water daily, using throat lozenges for sore throat relief, and considering saline nasal sprays or rinses for congestion are also recommended.
When to Seek Medical Attention
- If symptoms persist or worsen, such as high fever (over 101°F), difficulty breathing, or symptoms lasting more than 10 days.
- If underlying conditions like asthma or COPD are present, as they may require more urgent medical evaluation and management.
Antibiotic Use
- Antibiotics are only recommended for patients with a confirmed diagnosis of group A streptococcal pharyngitis, as they do not provide benefit for viral infections and contribute to antibiotic resistance 1.
From the Research
Diagnosis of Pharyngitis
The diagnosis of pharyngitis, which is characterized by inflammation of the pharynx, involves identifying the underlying cause of the condition. Pharyngitis can be caused by various factors, including:
- Viral infections, which are the most common cause of pharyngitis in children 2
- Bacterial infections, such as group A beta-hemolytic streptococcal infections, which are a significant cause of pharyngitis in both children and adults 3, 2, 4
- Other less common causes, including mycoplasmal and chlamydial pharyngitis, and gonococcal pharyngitis 3
Symptoms and Diagnosis
The symptoms of pharyngitis can include congestion, coughing, and a sore throat. To diagnose pharyngitis, healthcare providers may use a combination of physical examination, medical history, and diagnostic tests, such as throat cultures or rapid streptococcal antigen tests 2, 4. In some cases, the diagnosis may be challenging, and healthcare providers may need to consider multiple potential causes of the symptoms 5, 6.
Complications of Pharyngitis
If left untreated, pharyngitis can lead to complications, such as post-streptococcal glomerulonephritis and pulmonary-renal syndrome (PRS), which is a rare but potentially life-threatening condition characterized by rapidly progressive glomerulonephritis and diffuse alveolar hemorrhage 5. Prompt recognition and treatment of pharyngitis are essential to prevent these complications and improve patient outcomes.
Emerging and Reemerging Pathogens
Healthcare providers should be aware of emerging and reemerging pathogens that can cause pharyngitis, including viruses, bacteria, yeast, fungi, and parasites 6. These pathogens can affect unique populations, such as immunocompromised or unvaccinated individuals, and may require specialized diagnostic testing and treatment.