What is the prescription for voice loss due to pharyngitis?

From the Guidelines

For voice loss due to pharyngitis, I recommend against the routine use of antibiotics, as most cases are viral in origin and do not benefit from antibiotic treatment, as stated in the clinical practice guideline: hoarseness (dysphonia) (update) 1.

Key Considerations

• The majority of pharyngitis cases are caused by viral infections, which do not respond to antibiotics.
• Antibiotics should only be prescribed if there is a confirmed bacterial infection, such as group A streptococcal pharyngitis.
• The use of antibiotics can lead to unnecessary side effects, contribute to antibiotic resistance, and increase healthcare costs.

Supportive Care

• Voice rest is essential during recovery, minimizing talking and avoiding whispering, which can strain the vocal cords more than normal speech.
• Staying well-hydrated with at least 8-10 glasses of water daily and using a humidifier to maintain moisture in the air can help alleviate symptoms.
• Steam inhalation for 10-15 minutes several times daily can provide additional relief.
• Avoiding irritants like smoking, alcohol, and caffeine is also recommended.

Monitoring and Follow-Up

• If symptoms do not improve within 7-10 days of treatment, or if difficulty breathing or swallowing occurs, seek immediate medical attention, as this could indicate a more serious condition requiring different intervention, as advised in the clinical practice guideline: hoarseness (dysphonia) (update) 1.
• Clinicians should assess patients with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated, as recommended in the clinical practice guideline: hoarseness (dysphonia) (update) 1.

From the Research

Voice Loss and Pharyngitis

• Voice loss can be a symptom of pharyngitis, which is an inflammation of the pharynx and surrounding tissues 2.
• Pharyngitis can be caused by viral, bacterial, or fungal infections, with viral causes being often self-limiting and bacterial and fungal infections typically requiring antimicrobial therapy 2.

Prescription for Pharyngitis

• The preferred antibiotic for treatment of acute GABHS pharyngitis is penicillin, or erythromycin in a penicillin-allergic patient 3.
• Penicillin and amoxicillin are the antibiotics of choice for the treatment of pharyngitis, with macrolides reserved for patients allergic to penicillin 4.
• Antibiotic treatment of adult pharyngitis benefits only those patients with GABHS infection, and limiting antibiotic prescriptions to patients who are most likely to have GABHS infection is recommended 3.

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 2.
• Clinically screen all adult patients with pharyngitis for the presence of the four Centor criteria: history of fever, tonsillar exudates, no cough, and tender anterior cervical lymphadenopathy (lymphadenitis) 3.
• Management algorithms that include the use of predictive clinical rules and rapid tests have been set up to help clinicians better predict suspected bacterial aetiology and prevent unnecessary prescriptions of antibiotics 4.