Management of Throat Ache Due to Viral Fever
For throat pain from viral fever, use ibuprofen as first-line treatment for superior pain relief, maintain adequate hydration, and avoid antibiotics entirely as this is a self-limiting viral illness that typically resolves within 7-14 days. 1
Symptomatic Pain Management
Ibuprofen is the preferred analgesic over paracetamol (acetaminophen) for viral throat pain because it provides more effective pain relief after 2 hours, superior antipyretic efficacy, and longer duration of action. 1 Paracetamol remains an acceptable alternative with comparable safety when used at recommended doses. 1
- NSAIDs like ibuprofen and naproxen are specifically recommended for symptomatic treatment of acute sore throat. 2
- Do not use antipyretics solely to reduce body temperature—use them to treat fever plus other symptoms that cause discomfort. 3
- Continue analgesics only while symptoms of fever and pain are present. 3
Hydration and Supportive Care
- Advise patients to drink fluids regularly to avoid dehydration, but no more than 2 liters per day. 3
- Supportive care including adequate hydration and rest is the primary indicated treatment for viral pharyngitis. 4
- Throat lozenges and salt water gargles can provide additional symptomatic relief. 4
Expected Clinical Course
Without antibiotics, acute viral sore throat typically peaks within 3 days and resolves within 7-14 days. 1 The mean duration is approximately 7 days with self-management. 2 Patients should be reassured that viral pharyngitis symptoms typically last up to 2 weeks with gradual improvement using supportive care alone. 4
Critical Pitfall: Avoiding Unnecessary Antibiotics
Antibiotics are not indicated for viral pharyngitis and provide no benefit while causing harm through adverse effects. 4 The majority of throat infections are viral in origin and resolve without antibiotic treatment. 5
- Most sore throats (>65%) are viral rather than bacterial. 2
- Antibiotics should not be prescribed for viral pharyngitis or for prevention of suppurative complications in low-risk patients. 1
- Even when bacteria are present, many infections resolve just as quickly without antibiotics. 5
When to Consider Bacterial Infection
If bacterial pharyngitis is suspected, apply the Centor criteria (fever by history, tonsillar exudates, tender anterior cervical adenopathy, absence of cough). 1
- Patients with 0-2 Centor criteria have viral etiology—antibiotics are not indicated. 1
- Patients with 3-4 Centor criteria should be considered for rapid antigen detection testing for Group A Streptococcus before any antibiotic consideration. 1
- Cough, coryza (runny nose), and diarrhea are more common with viral pharyngitis. 6
Additional Supportive Measures
For patients with distressing cough accompanying viral fever, simple measures should be tried first:
- Encourage patients to avoid lying flat on their back, as this makes coughing ineffective. 3
- Honey can be used for cough relief in patients over 1 year of age. 3
Red Flags Requiring Further Evaluation
Return for immediate care if: 4
- Symptoms worsen or persist beyond 2 weeks
- High fever develops (>39°C)
- Difficulty breathing or swallowing
- Severe headache
- Development of splenomegaly (consider infectious mononucleosis)