Treatment of Viral Pharyngitis
Viral pharyngitis requires only symptomatic treatment with acetaminophen or NSAIDs—antibiotics should never be prescribed as they provide no benefit and contribute to antibiotic resistance. 1
Confirming Viral Etiology
Before treating as viral pharyngitis, ensure the patient has clinical features strongly suggesting viral rather than bacterial infection:
- Do not test for Group A Streptococcus if the patient has cough, rhinorrhea (runny nose), hoarseness, or oral ulcers—these features indicate viral etiology 1
- Testing is only warranted if features suggest possible streptococcal infection: sudden onset, fever, cervical lymphadenopathy without cough or nasal symptoms 1
Symptomatic Treatment Approach
Pain and Fever Management
- Prescribe acetaminophen or NSAIDs for moderate to severe symptoms or fever control 1
- Never use aspirin in children due to the risk of Reye syndrome with viral infections 1
Additional Symptomatic Measures
- Topical anesthetic agents (ambroxol, lidocaine, benzocaine) may provide temporary relief 1
- Warm salt water gargles can relieve symptoms in patients old enough to gargle 1
What NOT to Do
Avoid Antibiotics
- Antibiotics are absolutely contraindicated for viral pharyngitis—they provide zero benefit and drive antibiotic resistance 1
- The typical course of viral sore throat is less than 1 week without antibiotics 1
Avoid Corticosteroids
- Do not routinely prescribe corticosteroids—they reduce symptom duration by only approximately 5 hours while carrying potential adverse effects 1
- The minimal benefit does not justify routine use 1
Patient Education Points
- Reassure patients that viral pharyngitis is self-limited and typically resolves in less than 1 week 1
- Explain that antibiotics are not needed and would not help viral infections 1
- Emphasize infection control: regular handwashing with soap and water, avoiding sharing personal items, and covering mouth when coughing or sneezing 1