What is the treatment for a viral throat infection?

Treatment of Viral Throat Infection

For uncomplicated viral throat infections, symptomatic treatment with ibuprofen or paracetamol (acetaminophen) is the primary management approach, with antibiotics specifically contraindicated unless bacterial infection is confirmed. 1, 2

Symptomatic Management

First-Line Analgesics

• Ibuprofen is the preferred first-line agent for pain and fever relief, providing superior pain control compared to paracetamol, with more effective relief after 2 hours, better antipyretic efficacy, and longer duration of action 2
• Paracetamol (acetaminophen) is an acceptable alternative with comparable safety profile when used at recommended doses 2
• Both agents address the primary symptoms of fever and throat pain while the viral illness runs its natural course 2

Expected Clinical Course

• Viral pharyngitis typically peaks within 3 days and resolves within 7-14 days without specific antiviral therapy 2, 3
• Most viral throat infections are self-limiting and do not warrant antibiotic treatment 3, 4

When Antibiotics Are NOT Indicated

Clinical Decision-Making

• Patients with 0-2 Centor criteria (absence of fever, tonsillar exudates, tender cervical lymphadenopathy, or presence of cough) should receive symptomatic treatment only 1, 5, 2
• Viral symptoms such as cough, rhinorrhea, or conjunctivitis indicate viral etiology and testing for bacterial infection leads to false-positive results in carriers and unnecessary antibiotic use 5
• Antibiotics should not be prescribed based on clinical features alone without microbiological confirmation, as clinical features cannot reliably distinguish bacterial from viral pharyngitis 5

Red Flag Symptoms Requiring Urgent Evaluation

Life-Threatening Complications

While viral pharyngitis is typically benign, certain presentations require immediate assessment:

• Difficulty swallowing, drooling, or neck swelling suggests peritonsillar abscess, parapharyngeal abscess, or epiglottitis 5, 6
• Severe unilateral throat pain with trismus and uvular deviation indicates peritonsillar abscess 5
• Persistent fever with neck pain in adolescents/young adults requires consideration of Lemierre syndrome (suppurative thrombophlebitis of internal jugular vein) 5, 6
• Stridor, sitting forward position, and respiratory distress suggest epiglottitis, which is an airway emergency 1

Adjunctive Therapies

Over-the-Counter Options

• Lozenges containing amylmetacresol/2,4-dichlorobenzyl alcohol or hexylresorcinol have demonstrated virucidal effects in vitro against respiratory viruses and may provide both symptomatic relief and local antiviral effects 7
• Echinacea/Salvia lozenges have shown reduction in viral load (62% after single lozenge, 96% after 4 days) and symptom improvement in observational studies, though this represents lower-quality evidence 8

Therapies to Avoid

• Zinc gluconate, herbal treatments (other than those mentioned), and acupuncture should not be recommended due to conflicting evidence, higher adverse effects, or insufficient reliable evidence for efficacy 1

When to Reassess

Persistent Symptoms

• Sore throat lasting beyond 2 weeks is atypical and warrants evaluation for non-infectious causes and serious pathology, as most viral and bacterial pharyngitis resolves within 7 days 1
• Consider laryngoscopy to visualize the larynx and pharynx, and evaluate for non-infectious etiologies such as gastroesophageal reflux disease or neoplastic processes 1
• Clinical re-evaluation within 1-2 days is essential for patients with severe symptoms to differentiate between harmless and serious disease courses 6

Critical Pitfalls to Avoid

• Do not prescribe antibiotics empirically without clinical assessment, as over 60% of adults with sore throat receive unnecessary antibiotics 1
• Do not test patients with clear viral symptoms (cough, rhinorrhea, conjunctivitis), as this leads to false-positive results in carriers and inappropriate antibiotic use 5
• Maintain high suspicion for complications in patients with unusually severe presentations, lack of response to initial therapy, or red flag features 1, 5