What is the treatment for pharyngitis?

From the Guidelines

To treat a sore throat, start with over-the-counter pain relievers like acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours to reduce pain and inflammation, as most sore throats are viral and resolve within 5-7 days without antibiotics. Gargle with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily to soothe irritation and reduce swelling, as suggested by 1. Throat lozenges containing benzocaine or menthol can provide temporary relief, as can throat sprays like Chloraseptic. Stay hydrated with warm liquids like tea with honey (avoid giving honey to children under 1 year), and use a humidifier to add moisture to the air. Rest your voice and avoid irritants like smoking or secondhand smoke.

Key Considerations

• Most sore throats are viral and do not require antibiotics, as stated in 1.
• Antibiotics, such as penicillin or amoxicillin, are only recommended for strep throat or other bacterial infections, and should be taken for a full 10-day course, as recommended by 1.
• For patients with penicillin allergies, alternatives like azithromycin may be used, as suggested by 1.
• It is essential to seek medical attention if the sore throat is severe, lasts longer than a week, is accompanied by difficulty breathing or swallowing, or if you have a high fever, as these may indicate a more serious infection, as warned by 1.

Treatment Options

• Over-the-counter pain relievers: acetaminophen (Tylenol) 325-650mg every 4-6 hours or ibuprofen (Advil, Motrin) 200-400mg every 6-8 hours, as recommended by 1.
• Gargling with warm salt water: 1/4 to 1/2 teaspoon of salt in 8 ounces of warm water, several times daily, as suggested by 1.
• Throat lozenges: containing benzocaine or menthol, as mentioned in 1.
• Throat sprays: like Chloraseptic, as mentioned in 1.
• Antibiotics: penicillin or amoxicillin for strep throat or other bacterial infections, as recommended by 1.
• Alternatives for penicillin allergies: azithromycin, as suggested by 1.

From the FDA Drug Label

In the treatment of streptococcal infections of the upper respiratory tract (e.g., tonsillitis or pharyngitis), the therapeutic dosage of erythromycin should be administered for at least ten days. The treatment for sore throat caused by streptococcal infections can be done using erythromycin for at least ten days 2.

• The dosage is usually 250 mg four times daily in equally spaced doses or 500 mg every 12 hours.
• For children, the dosage is 30 to 50 mg/kg/day, in equally divided doses.
• For more severe infections, this dosage may be doubled but should not exceed 4 g per day.

From the Research

Sore Throat Treatment Overview

• Sore throat is a common reason for consultation of family physicians, and it is usually triggered by infections of the pharynx 3.
• Less than 35% of cases are caused by bacterial infections, but antibiotics are prescribed far more often 3.
• Evidence-based guideline recommendations are available to reduce non-indicated administration of antibiotics in the treatment of sore throat 3, 4.

Symptomatic Treatment

• Patients should be encouraged in self-management, and ibuprofen and naproxen are recommended for symptomatic treatment 3, 4.
• Aspirin or nonsteroidal anti-inflammatory agents (NSAIAs) are advised in adults and NSAIAs in children for the treatment of pain 5.
• NSAIAs relieve pharyngitis pain better than acetaminophen 5.

Antibiotic Treatment

• If antibiotics are considered, clinical scores (Centor, McIsaac, FeverPAIN) should be used to assess the risk of bacterial pharyngitis 3, 4.
• Penicillin remains the first choice, with clarithromycin as an alternative for those who do not tolerate penicillin 3, 5, 4.
• The antibiotic should be taken for 5-7 days 3, 4.
• Antibiotics probably reduce the number of people experiencing sore throat, and reduce the likelihood of headache, and some sore throat complications 6.

Diagnosis and Treatment Approach

• A thorough history is key to diagnosing pharyngitis, and rapid antigen detection tests should be reserved for concerns about antibiotic initiation 7.
• Physicians should exercise restraint in antibiotic initiation for pharyngitis, as restraint does not delay recovery or increase the risk of S pyogenes infections 7.
• The updated German clinical practice guideline on sore throat provides evidence-based recommendations for treatment in the German healthcare system 4.