Supportive Treatment of Viral Pharyngitis
For viral pharyngitis, use acetaminophen or NSAIDs for pain and fever control, avoid antibiotics entirely, and consider topical anesthetic agents or warm salt water gargles for additional symptom relief. 1
Pain and Fever Management
Acetaminophen or NSAIDs (such as ibuprofen) are the first-line treatments for moderate to severe symptoms or fever control. 1 NSAIDs demonstrate superior efficacy compared to acetaminophen for reducing both fever and pain in pharyngitis patients. 2, 3
- Never use aspirin in children due to the risk of Reye syndrome, particularly with viral infections. 1, 4
Topical Symptomatic Relief
Several topical options can provide temporary symptom relief:
- Topical anesthetic agents containing ambroxol, lidocaine, or benzocaine may provide temporary symptomatic relief. 1, 2
- Warm salt water gargles can provide symptom relief for patients old enough to gargle safely. 1, 2
- Medicated throat lozenges used every two hours are effective for symptom control. 3
Research evidence supports chlorhexidine/benzydamine mouth spray as significantly reducing pain on days 3 and 7 compared to placebo, with improved quality of life. 5
What NOT to Do: Critical Pitfalls
Do not prescribe antibiotics for viral pharyngitis - this provides zero benefit and contributes to antibiotic resistance. 1 The Infectious Diseases Society of America and CDC strongly recommend against antibiotic use in viral pharyngitis. 1
Do not routinely use corticosteroids - while they may reduce symptom duration by approximately 5 hours, this minimal benefit does not outweigh potential adverse effects. 1, 2 The IDSA explicitly recommends against corticosteroids as adjunctive therapy. 2
Confirming Viral Etiology
Testing for Group A Streptococcus is not necessary when clinical features strongly suggest viral etiology, including:
These features distinguish viral from bacterial pharyngitis and help avoid unnecessary antibiotic prescribing. 1
Patient Education
Reassure patients that viral pharyngitis typically resolves in less than 1 week without antibiotics. 1 Explain that antibiotics are not needed for viral sore throats and focus treatment on symptomatic relief with analgesics and topical measures. 1