From the Guidelines
Viral pharyngitis treatment is primarily supportive care since antibiotics are ineffective against viral infections. Treatment includes adequate hydration, rest, and pain management with acetaminophen (325-650 mg every 4-6 hours, maximum 3000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food, maximum 3200 mg daily) 1. Throat lozenges, warm salt water gargles (1/4 to 1/2 teaspoon salt in 8 ounces of warm water), and honey in warm tea can provide symptomatic relief. Most cases resolve within 7-10 days without specific antiviral therapy. If symptoms persist beyond 10 days, worsen after initial improvement, or include high fever (>101°F/38.3°C), severe pain, difficulty breathing/swallowing, or dehydration, medical evaluation is recommended to rule out bacterial infection or complications. Viral pharyngitis is typically caused by rhinovirus, coronavirus, adenovirus, or influenza virus, which trigger inflammation of the throat tissues but generally resolve with the body's immune response without requiring targeted medication.
Key Considerations
- The majority of pharyngitis cases are viral in origin, with common causes including rhinovirus, coronavirus, adenovirus, herpes simplex virus, parainfluenza, enterovirus, Epstein–Barr virus, cytomegalovirus, and influenza 1.
- Patients with a sore throat and associated symptoms, including cough, nasal congestion, conjunctivitis, hoarseness, diarrhea, or oropharyngeal lesions (ulcers or vesicles), are more likely to have a viral illness and should not have further testing 1.
- Providers must rule out group A Streptococcus, the predominant bacterial pathogen, and exclude more serious infections 1.
- Antibiotics are not recommended for viral pharyngitis, as they are ineffective against viral infections and may have adverse effects 1.
Symptomatic Relief
- Over-the-counter symptomatic relief has a low incidence of minor adverse effects, including nausea, vomiting, headache, and drowsiness 1.
- Patients can be assured that the typical course of a sore throat is less than 1 week and that antibiotics are usually not needed because they do little to alleviate symptoms and may have adverse effects 1.
From the Research
Treatment of Viral Pharyngitis
- The use of aspirin or nonsteroidal anti-inflammatory agents (NSAIAs) is advised in adults and NSAIAs in children for the treatment of pain in viral pharyngitis 2.
- Studies have shown that NSAIAs relieve pharyngitis pain better than acetaminophen 2.
- Steroids may provide a useful adjunct in the management of acute pharyngitis, but there is currently insufficient evidence to endorse routine use 3.
- Lidocaine 8 mg sore throat lozenges have been found to be superior to placebo for all efficacy parameters investigated in the treatment of acute sore throat 4.
Management Approach
- A thorough history is key to diagnosing pharyngitis, and rapid antigen detection tests should be reserved for concerns about antibiotic initiation 5.
- Physicians should exercise restraint in antibiotic initiation for pharyngitis, as restraint does not delay recovery or increase the risk of S pyogenes infections 5.
- Viral causes of pharyngitis are often self-limiting, while bacterial and fungal infections typically require antimicrobial therapy 5.